The Psychology of Perfectionism: The struggle to be good enough with Dr. Paul Hewitt Part 1

Dan and this week's guest, Dr. Paul Hewitt, embark on a quest into the psychology of perfectionism.

Paul Hewitt is a registered clinical psychologist and a Professor in the Department of Psychology at the University of British Columbia. He has published over 300 research papers, books, and chapters on perfectionism, psychopathology, and psychotherapy, was cited as one of the top 10 Canadian clinical psychology professors for research productivity, and was recently awarded the Donald O. Hebb Award for Distinguished Contributions to Psychology as a Science by the Canadian Psychological Association.

Dr. Hewitt discusses the complexities of perfectionism and its implications in psychotherapy. He emphasizes the importance of humility in clinical practice and shares personal anecdotes about his journey in understanding perfectionism. The discussion delves into the definitions, traits, and interpersonal expressions of perfectionism, highlighting its deep-rooted psychological impacts. Dan and Dr. Hewitt also outline therapeutic approaches to address perfectionism, focusing on the significance of a strong therapeutic alliance and the need for self-acceptance.

Special guest: Dr. Paul Hewitt

(free) Tools to assess perfectionism

Books on Perfectionism
- Perfectionism in Childhood and Adolescence: A Developmental Approach
- Perfectionism: A Relational Approach to Conceptualization, Assessment, and Treatment

Other resources
- Clients Struggling With Perfectionism
- Group Psychodynamic-Interpersonal Psychotherapy

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Transcript

Broadcasting the world I' Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia.

Welcome to episode number 23 of psychotherapy and applied psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights, pull back the curtain, and hopefully have some fun along the way.

If you didn't already know, you can check us out on YouTube. Just tap the link in the show notes, and while you're there, be sure to hit the like and subscribe buttons.

Hitting those buttons on YouTube and subscribing to the show on your podcast app keeps you in the loop and helps others find us too.

Today I couldn't be more excited to welcome, who I would argue is literally the world's authority on perfectionism.

My guest is a professor of clinical psychology here at the University of British Columbia.

He's a fellow of the Canadian psychological association.

He won the Heb award for distinguished contributions to psychology as a science, was cited as one of the top 10 Canadian clinical psychology professors for research productivity, and he also has several books that are worth checking out, such as perfectionism in childhood and adolescence and perfectionism, a relational approach to conceptualization, assessment and treatment.

In the show description I have links to his books and a link to his website, where there are tons of great free resources.

In part one of our conversation, we discuss what perfectionism is, perfectionism's three domains, how perfectionism is expressed interpersonally and treatment considerations.

This episode starts with my guest responding to my question about a time early in his career, when he experienced self doubt, so without further ado, it's my pleasure to welcome Dr. Paul Hewitt.

How about yesterday?

I mean, I think one of the one of the things I tried to both embrace and communicate to the people that I train, both researchers, but most especially the clinical, uh the psychotherapist that I train is is about humility. And about um being careful about how you view yourself and and that sort of thing.

And so it's I I will let my students know that I do clinical work all the time and there are often times when I don't know what's going on.

I I'm not quite sure what's happening.

And and a piece of that is actually the joy of doing psychotherapy because you don't know what's coming, but there still is a little piece that says, okay, am I going to be able to navigate this?

And I do pretty quickly wind up relying on my training and just reminding myself, don't you you know, stay sitting in the chair and listen and just do what you do and it will something will become clear as we move along.

And so, um in that sense, that's kind of a constant uh for me, um and I think to to just to remind myself about this, that every new person that walks in the door is incredibly unique, so I don't know what I'm going to run into whenever I start a process of psychotherapy, even though I may even be focusing on a particular domain, uh the uniqueness of each person is is always a bit of a challenge.

And, uh, again, that's that's part of the joy of doing psychotherapy, but um it's also the challenge of doing psychotherapy.

So I'm not sure if that fits what you're kind of looking for.

Nootally works.

Can you think of a time early on when you had sort of the opposite experience when you had a when you had a, oh, you know, maybe I can do this.

In graduate school, I started two file folders humble file and not so humble file, and so whenever anything kind of good like I got a scholarship or something, stick it in the not so humble file. And the humble file was quite a bit bigger, I have to say over over time.

I guess when when I was offered a position at UBC, uh that sort of gave me a sense of, oh, maybe I am doing something here that people can uh resonate with. Um I um so though those are moments that that I feel like, oh, okay, people are actually reading what I'm what I'm writing. Um And then there's the odd time I'll be walking from my office down the hall and there'll be a most especially in the summer, there'll be a student visiting from somewhere who came to the department hoping to bump into me because they've read some of my works I have yesterday, actually.

And I I mean, I am it's it's very powerful when that happens that somebody actually walks across the campus just to hope that they might be able to chat a few minutes.

And that I find that uh incredibly powerful. And I try to be as gracious and as accommodating as I can, uh, you know, in the middle of a day.

But um those are moments that I think, okay, well, maybe this is resonating with some people.

So can you remember can you remember when can you can you do you have like a visceral memory of when you when you found out that like when you got the offer from UBC sort of like where what what was that?

Like was it a letter you opened, a phone call you got?

I think it was a phone call from a colleague.

I didn't know her very well, but but Professor Lin Alden, who was one of the people that sort of encouraged me to apply.

And I think she told me and I was I was I was stunned in two ways first off because our clinical program at UBC has been has the reputation of of being a very behavioral, uh cognitive behavioral and not particularly pleased with a psychoanalytic or psyodynamic perspective.

And that was my perspective and I spoke that in my job interviews and that sort of thing.

So, uh, on the first hand, I was I was kind of taken aback a bit by that. Um, but also that, um these, uh I had this, I'd always seen the psychology program at UDC as, um, indeed as it is, is a very powerful uh research facility.

And so there was a bit of that, not a bit.

There was that sense of impostor both.

I can't believe they offered me the job and am I up to the task of being a professor at UBC?

Um So yeah, that notion of imposter phenomenon that exists is firstly familiar to graduate students. Um and as many of us professionals, not just in psychology or academia, uh, can admit to, if we're honest, that absolutely there are moments uh throughout our career, but that sort of rears its head a little bit.

So So can you tell me about how you got into studying perfectionism?

Sort of two routes.

One um third year undergraduate taking a personality course and had to do a paper.

And it just so happens I had an appointment.

I think it was at a dentist's office or something and I was sitting in a waiting room in the days when they had magazines that you could touch and read. Um I look at this and a journal I was just reading some article waiting for my appointment and the journalist was talking about, just talk about perfectionism, and I had been looking for a topic to write a paper on in this course.

I thought, oh, that's interesting.

Maybe I should maybe I should think about that.

And so I went to the library and found yeah, people had were talked about it, but there was absolutely no research, not one empirical paper on perfectionism.

And so, uh as a third year, I thought, oh, well, this is interesting.

So I wrote a little bit about it and and found a few clinical vignettes here and there in the literature, wrote a little bit about that. Um and then the next year, my fourth year, I had to do an honor's thesis and I thought, oh, well, why don't I see if I can do a research project on perfectionism and then a master's thesis kind of same thing and then a PhD dissertation continued on and on and then applied for grants to to fill it out more and at the same time into clinical work with these issues.

And so it's it kind of started that way.

That's sort of one contribution to that.

The other is, um, I started, uh I studied uh a classical music.

I did a lot of classical music training. Early on and early on in university, that was the path I had dreamed of, actually taking..

I started out actually, uh classical guitar, um, but I also uh studied um voice uh for opera uh a little bit later with voice for opera.

But in that world, um elements of perfectionism are pretty endemic on a bunch of different levels.

And certainly in the clinical work I've done over the years with classical musicians, certainly, but other, but other artsy kind of folks, um there's um it it can be incredibly problematic for those folks. Uh and the demands uh can be um huge.

And so the perfectionism piece kind of made some some say I had some familiarity with that in in that way.

So those two pieces kind of uh there was a confluence, I guess, at some point of those two pieces.

And I just really became interested in it, but most especially each time I learned a little bit more about it either clinically or research-wise, it just led to a whole bunch of other what I found very interesting questions about how far how far do the negative implications of this personality style reach and how deep are they and how do we treat them?

So it's just been an evolution over well, let's see it was an undergraduate in 1981, so I've been thinking about and writing about that stuff since then.

So.

Well, that it's funny.

You probably don't remember this, but like, I don't know, seven, eight years ago, one of the first, uh, first or second time I met you, I asked you, I I asked you how long you'd been studying perfectionism and you said something like since I was 19 or something, whatever it was, 18, 19, 20, whatever it was, and that always stuck with me because I think that that's that's very unique.

You know, I mean, that that that the the primary construct that is like the hub of your work and your thinking really persisted from when you're an undergraduate.

Yeah.

And so I I encourage undergraduates to, you know, if you have an idea, absolutely pursue it, don't be dissuwayed by other people saying, uh, it's irrelevant because I got a fair amount of that over my career as well.

Don't study that.

Nobody's interested in that due depression research instead. , you know, I just sort of thought, well, I'm interested in it, so I'll I'll do what I'm interested in.

Yeah, it is interesting.

I mean, and you can see the logic behind that.

You can see the logic behind by somebody would say that, well, if you want to get funded, you know, studying this very fundable topic of depression is more strategically, you know, the thing to do rather than this somewhat, this colloquial, but, you know, this that you're turning into a uh rigorous subject. Very kindhearted advice from these people. Um and maybe that's just my stubbornness or whatever.

I just have I I'm interested in answer I'm going to see if I can do something about it.

So yeah, I mean, it makes, you know, if you're going to spend as many hours as one spends studying something, you know, make it something you care about.

Um So so okay, so let' let let's get into it.

So I want to do would it be reasonable to start off with asking how you how you define perfectionism.

And then is it reasonable to talk about it broadly before we get into sort of the uh quote unquote the subtype?

So you can change my language on this.

What is it reasonable or does it need do you think you need to really do the subtyes because it's so different?

Well, let me let me talk about it broadly first and then we can get into some of the weeds of it if you like.

For all, we and the majority of my thinking and conceptualizing comes from working with patients.

I yes, I do a lot of research.

Yes, I do a lot of reading in the field and I learn about it that way.

But in truth, the way I really learn about the people who have this pernicious personality style, the way I learn about is from the clinical work that I do.

And so the patients teach me about who they are, how they function, what they do, how they work and that informs me and it informs the way I think about about the construct.

It informs the way I develop treatments and how I do my psychotherapy with them.

And it also informs how what kind of research questions I ask.

And so I think that's been the really valuable part if if um you know, if I've made contributions in that domain, it has come from the clinical work that I have done with the people. Um and that that's informed that's informed to everything uh that I do.

So um when we're talking about, you know, the how we define perfectionism or conceptualized real quick, real quick, just because I think I just want to make sure I'm understanding you right, which is that a lot of your um insights, your like those uh seeds of ideas, those like, oh, well, maybe those are being a lot of those, the majority of those are come from your clinical experience.

Yes, and the the theoretical models that we've developed come from understanding people that I've worked.

So I'm always I'm not really studying perfectionism.

I'm studying people who have perfectionism.

So it's a again, it's a softbook distinction.

But one, that's really evident if you read by especially how we do conceptualize the psychotherapy uh that we conduct.

But the way we view perfections is a broad, pernicious personality style.

It's that multiimensional, multi-layered at multilevel.

So lots of times people think of perfectionism.

And these are, you know, other academics or clinicians or people in general, kind of as a set of attitudes or thoughts or cognitions. And we say no, that's no, perfectionism is is much broader than that and it's deeper than that.

So we think of perfectionism in terms of three broad domains.

One domain, and I should and as I said, this comes from learning about it through working with patients, but also doing research kind of at the same time and trying to confirm, you know, kind of what we see.

But the three very broad domains involve perfectionism traitits.

So elements of perfectionism that function like personality traits do.

They provide the energy and the drive for particular kinds of behaviors.

So when we talk about perfectionism traits, we're talking about really about individuals who have a need to be perfect or a concern with being perfect, and they need to be perfect for themselves or for other people, they can be relatively independent of one another.

But in essence, there there's this need to be perfect that kind of provides the drivers and the energizers of the actual behavior that people exhibit.

So we have these traits.

We've talked about three, uh three main traits that we've I've identified clinically, but also research wwise, we say yet these three traits seem to hold.

One is, I I' not there's a form of uh trait perfectionism animals.

I need me to be perfect.

So it's self- oriented perfectionism.

It's um I require perfection of myself.

Okay.

And it's not that I feel like I should be perfect or I think I should be perfect.

It's a drive and a requirement to be perfect.

Okay?

So it's it's deeper than simply thinking about it.

It's a powerful , it's a relational drive, a deep drive.

Another component is I don't need me to be perfect, but I need you to be perfect, so um that's other oriented perfectionism where I may need my children to be perfect.

I may need my graduate students to be perfect.

I may need everybody on the freeway to be driving to be perfect or or in general I need everyone to be perfect.

And again, it's not that I need me to be perfect, but I need others to be perfect. And then the third trait component involves the perception that others require me to be perfect.

So I may go through life with the belief that my parents need need me or needed me to be perfect.

My my spouse needs me to be perfect. The world needs me to be perfect, uh, etc.

So those are three trait components.

All serve the purpose of the individual being concerned with needing to be perfect.

So it can be both people will strive and drive to try to be perfect, but they may not be actively striving or driving, but they may be concerned with striving and driving to be perfect.

So that's that one component.

The other the other component is, um and this is really where the psychodynamic portions come in, is um an interpersonal expression of perfection.

So, uh you may be able to think of individuals that you would describe as perfectionistic as I've described it so far people who need to be perfect, but you also may be able to identify people who they don't really need to be perfect, but boy do they need to present themselves or appear to others as if they're perfect.

And so it's this interpersonal expression of perfection.

So if you think of kind of any politician, one of the drivers of their behavior is needing always to try to appear as if they're doing a perfect job, and it kind of goes along with the territory, but some people's personality are kind of characterized by that.

So again, they don't need to be perfect, but they need to appear to others as if they're perfect.

So that's that second piece.

Now there are three ways to try to appear perfect to others.

One is, I can I can it's called perfectionistic self promotion.

I can promote myself as perfect to you, so I can tell you how wonderful I am how perfect I am.

I can demonstrate to you these things that I do perfectly, and you know, as soon as I say that you have a sense of okay, here we're talking about a narcissistic process and very much and that is one element to try to convince you that I'm perfect.

Another way is never to er demonstrate to you anything I do that would be less than perfect. So I'm not going to speak in public because I might stumble over a word or stutter or mispronounce something, and I cannot display any behavior in in in that way that will demonstrate an imperfection that I have, so I will not display any behavior that I believe is less than perfect..

So the optptius, if you don't see any imperfect behavior, you're going to believe me to be perfect, and then the last piece is I will never disclose to you any imperfection.

So in a conversation with you or in a yeah, just in an interaction with you, I won't talk to you or tell you or reveal verbally any piece of me that is less than perfect.

Okay?

And again, once I sort of say that a lot of people assume right away, okay, well, yeah, I can see that intimacy is going to be a real problem for those folks.

Relationships are going to be a real problem for those individuals indeed.

And then going to add so just uh, I don't know if this is the right time to do it.

But so we sort of have these two broad framings and so one is a need for a need per for perfection and the other is uh a sort of a Yeah, a need to appear perfect.

Yes.

Okay.

Yes.

And they're distinct from one another.

Got it.

Okay.

And then so and then within each one of these, you have there are these three different ways different ways to kind of manifest those And are they are the are the I guess there's a couple levels.

So one, the need for perfection and then that interpersonal expression of perfection, sort of the general, what do those two things tend to show up in the same people?

And then, you know, do they sort of, you know, covary typically or often?

And then, of course, the other question is within those, when you have those three different, you know, that I need to be perfect, I need you to be perfect or others need me to, you know, do those sort of sub those co very You know, it's I'm glad you asked that because when you present and when you teach people about this stuff, you teach them as these separate independent constructs, and you have to do that in order to get people to understand the constructs.

Memori I study people, I don't just study con in people, they overlap, they combine their like it can be quite complex.

So yeah, there can be fairly consistent covariance between different elements, but you get all sorts of combinations of those behaviors.

And those behaviors can show up at different times in a person's life as well.

So a person may have more of a concern about not displaying an imperfection at one point, given the circumstance of what they're doing in their life, and then at another point, you know, maybe more focused on not disclosing and imperfection.

Is there a is there a like, um, is one aspect of this, like the uh, the a lack of flexibility from like situation to situation.

So let's just take that I need me to be perfect, sort of just uh to simplify it, that, you know, if I'm a musician, right?

If I'm a classical musician and I am there's a certain, you know, you're auditioning or you have whatever, right?

There are certain times when like a a ridiculously elevated drive for perfection is sit situationally uh valuable and even adaptable or adaptive, where, but if I was that musician and I and I didn't keep it really isolated, you know, I brought that into all sorts of other places and even, I you can see how maladaptive it would be where when I'm sitting in the practice room by myself, there's nobody else there, that oftentimes you don't want to be perfect.

You know, you want to push yourself, right?

So you want to make mistakes.

You want to let that be okay in that space.

But if I'm telling myself, I can't do that here, right?

That's going to be maladaptive even in terms of your musical abilities or use musical achievement.

Sure. What you're describing has been one kind of conceptualization of perfectionism.

What what I'm talking about is not trying to perfect things or tasks or performances at the root of all of this is I'm trying to perfect my self that at where it comes from is, I have a deeply flawed sense of myself.

I should say that differently the sense of my I have a sense of myself as being flawed defective, not good enough. Okay.

And that there's something fundamentally wrong with me.

And in order to deal with that, I have I will choose, if I'm perfect, then I'll be good enough and use perfectionism as a way of trying to repair or correct the to not be flawed and defective, so if there is a difference between going into situations and tasks attempting to correct the sense of being flawed and defective, and the sense of trying to have a perfect performance.

So um uh there's a um uh a researcher by the name ofudro at the University of Ottawa, uh started up in the perfectionism field and moved toward talking instead about perfectionism as being healthy and adaptive, which I always thought was a crazy idea anyway.

But he he calls it excellencism, and there's a real distinction between striving for excellence and really high level of performance and striving for perfection.

And they're they're very different.

And that's always the way I've thought about it.

But he he took the ball and conceptually said, well, um this isn't striving for a really good performance and high standards, uh is not perfectionism.

That we've got to call that excellenism.

Used to call it high achievement striving, even hyperconscientiousness healthy, adaptive, potentially adaptive things, whereas the perfectionism is maladaptive.

So there's a there is a distinction that's there.

So if I need to try to correct this flawed sense of who I am, there can be a variety all of the domains I can be focusing on in order to try to do that.

If I happen to have a talent in one domain, it's not that I have to be um you know something that I'm trying to be the perfect javelin thrower in the Olympics.

It's that I'm trying to correct a sense of being flawed by being a gold medal winner up in javelin throwing in the Olympics, and what people discover is even if they win that gold medal.

It doesn't fix that flawed sense of self. But so the the the again, from a psychodynamic perspective, we're trying to understand what's driving and pushing and motivating the behavior, what's causing the existence of perfectionism, and in the theoretical work we've done, we talk about, okay, well, there's a need to have a sense of being good enough, a need for self esteem, a need to feel like I'm an okay person in the world.

There's also a need to fit and belong and be acceptable to others.

Okay.

So and those are the drivers and when those two needs, fundamental basic needs are thwarted, um one strategy strategy is maybe not exactly the right word, but one of the things that people learn often as children, while if I'm perfect, then I will be I won't be flawed any more, or if I'm perfect, then I'll be acceptable.

I won't be rejected.

I won't be abandoned by other people.

I won't be ridiculed, humiliated. Um and so they use trying to be perfect or appear to be perfect.

They use that as a way to try to repair, uh repair the self or by feeling better about the self or by being acceptable to others.

So you said that there there were two specific needs that you were thinking about and I just give you I missed it.

I mean, one is called a need for self-esteem.

I need to feel like I am good enough, like I am acceptable in uh in my own judgment that I'm a good decent person, um that I'm a deserving person.

So that I mean, we could call that broadly need for self-esteem, but it that term itself is not it's not just self esteem. That self esteem has too many connotations with it that it doesn't quite capture that sense of um I don't have a real sense of identity.

I don't have a cohesive self, and if I'm perfect, then I will feel whole.

So if that sort of that's one driver, the other driver um would be to feel like I fit in the world I belong somewhere I belong with people.

I'm acceptable to others.

I matter to other people. Um I'm important.

I'm relevant. Um other people care for me.

I'm lovable. Uh so that drive that's another powerful driver. Uh and so very often you hear patients talk about needing to be perfect in order that other people will care for me, or most particularly won't criticize me, won't reject me, uh, won't think of me asanger weird. Um So those are the two fun I mean, we' we've gone from describing what perfectionism is to the actual model of how of how it develops and and what drives the behavior.

But it's at that deeper level, uh where we're the person is using trying to be perfect or appear to be perfect to fix themselves or to fix their position in the world.

And I, you know, I would say one of the things that I'd thought about before having this conversation is like trying to really sort of nail down how you're thinking about perfectionism is different from colloquial, you know, you thinking and uses of the term.

And I think, I mean, you're really nailing it right at the outset here, which is that this this idea of, you know, I need to be perfect or, you know, others need like that underlying belief.

I mean, a belief might, but like a like a foundational framing of everything.

It's a philosophy of life, sometimes we call it, a way of being in the world, as I'm not good enough and I have to be perfect in order to be good enough to have a to have a place to have a sense of self that I'm okay.

So it's very it's a very fundamental a very fundamental deep needs that if they're thwarted in some sort of how they're not the needs aren't met.

I mean, like any like we always when we have a powerful need that's not being met we try to do something about it.

And one of the ways that people learn to try to do something about it.

And again, it's often very early in their life. Is this notion if how perfect that that's the solution to this and doggedly pursue it.

And intriguingly, like the the paradoxes, uh people will hold on to this notion that if you know if I can be perfect, then I'm going to be cohesive, then I'm going to fit and belong in the world. And we'll know the maxim nothing is perfect.

It's constant failure.

So they experience constant failure.

And, you know, from a behavioral perspective, if you punish something, it reduces its frequency.

So theoretically from that perspective, a perfectionistic person should experience failure and therefore not be perfectionistic any more, because they're not being rewarded for being perfect and it's not the case.

It's more this psychodynamic it's more consistent with a psychodynamic perspective that the perfection is that attempt to try to to meet these needs and there just don't work, so we typically increase the behavior even more, and people spend their lives attempting to perfect themselves and never ever doing it, and as a consequence lived pretty tortured, pretty tortured lives.

Well, when when you're talking about this, I think a lot about like the um some of the interpersonal theories of personality disorders and that this is, you know, that it's very much a that there are these maladaptive ways of responding to try to get these frustrated needs met, but they just don't work.

But we, but but you're right.

But like it's it's that is interesting to think about it from, you know, if we took a few a pure behaviorist's perspective and I'm sure behavior, you know, I'm sure there are some behaviorists that would have some very sophisticated ways of explaining this, which may be quite reasonable.

But that this idea of but we keep doing them, right?

So like, and that's what makes it maladaptive is, I want this thing, I have this tool that I'm going to use to get this thing, but it's the wrong tool, but we still continue to use it over and over and over it.

It's very interesting you say that because that's a piece of the treatment is.

I mean, we can't just say to people who start in therapy, oh, you have to stop using perfectionism because it's the wrong tool, but it's exactly what we're trying to do and teach the person experiially that that that trying to be perfect really does not work because indeed it is the wrong tool, and in fact, the whole premise of needing to be perfect or appear perfect is wrong about that sense of being flawed and defective that along the line somewhere in their life they have learned, and in some cases been taught, but mostly have learned that there's something wrong with me.

I'm flawed and defective.

I'm just not enough I'm not good enough and from that position they go forth and try to correct it by attempting to be perfect or some people will use narcissism.

Other people use dependency.

There's a variety of different pathways, but many people just try to be perfect or try to appear perfect in order to correct that.

So the work then becomes in indeed trying to be perfect is the wrong tool to try to feel cohesive and whole.

And so that's actually where we do the work of psychotherapy.

So I bounce it around a little bit here, but but when when I do therapy with people with perfectionism, very seldom does the concept or the term perfectionism come into the dialogue that we're working at we're working more at those underlying relational needs that gives give rise to the perfectionism.

So I because we're definitely going to jump into treatment stuff.

Bef before we get there a couple more things I want to make sure to hit.

So this like so that makes sense for me for the um the I need to be perfect or my perception that others need to be perfect.

What about this uh other oriented perfectionism, this sort of, I need you to be perfect?

Well, that's that's one of the perfectionism traits.

Actually, we haven't gotten to the third component of the of the come back to the other oriented to come back to the third component. Ent this point, just asked?

So it's one of the traits I need others to be perfect.

And if you know borderline pathology at all with diffuse boundaries, borrowing identities of other people, if you know borderline pathology is one of the they they don't have a sense of identity themselves.

They'll borrow others in order to have a sense of cohesiveness.

Other oriented is a similar phenomenon, so I need if we're friends out in public, I will need you to be perfect because whatever your like will reflect upon me, so that if you're a high status person or you're a superstar, I gain status I gain worth by your perfection.

So it's a borderline diffuse bound I borrow your identity.

And so I need my kids to be perfect, not because I want them to be successful.

I need them to be perfect because I'm going to look like a crappy parent if they're not. And so it it is the borderline pathological process that is evident in the other oriented uh other oriented perfectionism.

So and it ultimately comes back to a way to try to feel better about the self.

It's it's very pernicious.

That piece in particular is very pernicious. Um but it's it's quite it's it's quite different than uh needing self to be perfect or perceiving that others need you to be perfect.

Well, yeah, I mean, of course.

I mean, you know, if I believe that I need to be perfect, at least I have some control over that where if I need you to be perfect, I have probably little actual I mean, you know, control over that and the way I'm going to try to exert control, presuming that I am, is going to be not good Draconian, hostile, critical, um desperate. Um and you see this in you see in a variety of different ways, but sometimes you see it on the sports field with kids or you see it in other contexts where the the spouse to be perfect or even graduate students, uh, you know, professors who uh, you know, their graduate students performance is going to reflect absolutely on them.

And so they have to, you know, drive those students not to make a fool of the professor.

That's kind of the mechanism that that's there.

But again, very pernicious in that fashion.

Okay, third third third major have the traits that self-ather social, the drivers need to be perfect.

We've got the interpersonal expression, meaning, I'm going to present myself to you, Dan, as a perfect guest.

I'll tell you how wonderful I am, how wonderful my clinical skills, all of that sort of stuff.

I'm not going to tell you about what a horrible golfer I am.

I'm not going to show you something, you know those sorts of pieces.

But this third piece is the intrep personal expression of perfection that relationship I have with myself about the expression of perfectionism, a perfection, I should say.

And the best way to kind of capture that intrapersonal element is, um we all kind of have a dialogue with ourselves, um not constant, but it's it's there.

So when you get up in the morning and you're brushing your teeth, you have this conversation with yourself, like, okay, I've got to remember.

I I've got that appointment I have to get to.

I've got to pick up milk on the way.

And it's just a d benign kind of dialogue you have with yourself.

Well, we also know that sometimes that dialogue can be not so benign.

And for some end, that dialogue can be can be, you know, going into an interview.

I've got to do this perfectly.

I got to make sure I don't make any flaws.

I can't look like a fool.

And and again, this inner dialogue, um and at times it can also be highly critical.

How can I how could I do that?

How can I name it?

I'm so stupid.

No, you know, nobody cares about me.

I'm I'm this harshly critical internal dialogue.

And when you think about what that is, one of the things I'll say to patience is, if you took that dialogue you have about yourself, and you said that to your spouse, or you said that to your child with the same words, just change the pronoun what would happen Anne puplip what I'd be arrested?

I'd be thrown in prison?

I'd be I'd be divorced.

It would be incredibly abusive.

And so so we're talking about here, okay, but this is the nature of the relationship you have with yourself. Is that harshly perfectionistic, harshly critical peace.

And so we talk about that as the that interpersonal expression of it, but we also talk about it as a perfectionistic self-rel relationship, nasty, harsh, unforgiving, like at times horribly abusive uh in in extreme versions.

And so we've got those three pieces. Um the last one is a little bit or conceptually, um, but we're talking about the, you know, that harsh dialogue, but also um a lack of self-soothing, dialogue, a laugh of selfaffirming, uh, a lack of caring for the self, meaning that there's a lot of neglect of self, and this is the piece we believe is where the self harm comes in.

So perfection very highly associated with is very good research on suicide ideation, high intent suicide attempts, clinicians's rating of suicide risk, um and we believe it's that that piece, that perfectionistic self relationship that may be at the crux of the suicidal behavior with the perfectionistic individuals.

Could unpack that a little bit?

Sure. Just conceptually how you think about.

Okay, if you think about a um a continuum of the treatment of the self.

So on what at at one end, you've got, you know, affirming uh confident, self-caring kind of individual who both has a dialogue about uh, okay, I going into this very scary sort of situation.

I'm going to be okay.

I've done this before and the soothe and comfort the self.

That's at one end, um and then you can see movements toward the middle where maybe people aren't soothing of this self. Uh, uh, and they just have an absence of that and maybe some element of okay, well, I'm going to screw it up again and they become more and more negative about expectations too.

I'm not worthy to even care for myself that piece of self neglect.

I'm not worthy of caring. And you have a clinical practice.

You've seen you've seen patients who exhibit that you know, they just like they're not worthy enough to actually take care of themselves to further along the continuum too.

I'm so awful and horrible I don't even deserve to live.

So it's that relationship or something.

I' conceptually at this point, we're talking about how how it's related to suicide.

But the literature is out there, there are elements of soci prescribed especially is is a extremely good predictor of suicide behavior in in children, adolescents, adults.

Socially prescribed?

Yeah, where I'm I I believe that everybody or others require me to be perfect and I'm not able to be perfect.

And that that's a piece.

But we think it's actually the self- relationship that's most relevant in terms of the suicide.

So we've started some research to kind of address that.

I was also thinking, uh with the that self-relation thing as as you were describing it, that, you know, most suicide theories have some aspect of pain, like that people are in psychological pain, you know, whether you call it psych ache, obviously is one of the, but like that that if I if if if right, yeah.

And so like if I'm mean to myself, but also I don't soothe myself, which I mean, it's kind of a, you know, it's sort of this internal coping mechanism in this way of taking something and, you know, taking something challenging and calming it down a little bit.

But if I don't have that within me, then I don't have that internal, um, uh I want to say capacity, the the internal, you know, the knob that I can turn internally to reduce that pain.

So I'm stuck in it for longer, which makes it more um feels more unbearable, right?

And so then I just want to it makes the desire to die just more likely to happen because I don't see an end to this where I don't feel I have control of how to turn it down.

Or maybe, and, you know, from a uh with the, uh somebody with this int personal expression of perfection.

I'm not worthy of turning it down.

I should I should feel this pain.

I'm not.

I'm not deser to live.

Right.

It's it's about that worth,member, that def defective flawed, just not good enough for me, not good enough for other people, not good enough to be acceptable to other people.

And when you when you mentionedsychic, the Schneidman concept of psychic, would you work clinically with the perfectionistic people?

I I prepare my students for worked with them. The magnitude of pain that these people very frequently exhibit.

It's kind of breathtaking at times in therapy.

And once you sort of, you know, dig down in into some of that stuff about the flawed self, the defective self how that has manifested throughout their life and where it comes you get a you start to touch the the pain that's there and it is significant. Um So uh some of the exam when I do I do a lot of workshops, training workshops on what perfectionism is and how to treat it.

And I've got video clips of patients um and I kind of start out, let work out showing these clips of a couple of kids with perfectionism and then a couple of adults, and they're expressing some of the pain that's there.

And it is palpable in the room when you when you put these when you show the videos of just the depth of pain that's there.

What are some of the things that they say?

Well, it's it's it is about being despicable, being unloved that on the receiving end of messages about their uselessness in the world. Um and it's it's less about what they say and and how they kind of express it within this sessctions, you get a sense of the deep pain that's there.

So, um, you know, bone racking, weeping at times, you'll see that with with some of these.

Well, when you when you really touch down into some of the depth of some of the especially some of the beginnings and some of the early phases of the development of the of the perfections is very, very powerful.

Yeah, yeah.

How do you prepare your like How do I prepare the soup supervisory that I talk about it first off.

I show them some vignettes and that sort of thing.

And I said, just allow yourself to also feel the magnitude of that, but also get to feel the hopelessness because that's a deeply at a piece a piece of that deep pain for those ind individuals is the sense of hopelessness and helplessness, and again, as a therapist, you know that there's that level of emotion in the room it can spill over into the therapist, if you like, when you're not quite sure what and to sort of prepare them that way that no, that's just an effect of the affect that's in the room.

We just do what we do and and continue and it will cut the page will kind of move from that to to to get to a better spot reasonably quickly.

But you can the process of therapy will be touching on that periodically throughout the course of the treatment. , right.

So um I think it before I think I'm about a place to jump into the treatment side of things.

Is there anything else you want to hit that you think would be helpful or I mean obviously we can we can bounce back and forth, but Well, I mean, especiallyially what what I just wanted to describe is that that perfectionism is not simply a set of attitudes, uh thinking about being perfect.

It's it's this pernicious multi-layered, multi-level personality style that can manifest in a bunch of different ways in individuals.

And, you know, it's fine when you were, as you've been talking, I I, you know, a couple of times, as I sort of like, you know, I want to make clear to the listener how this differs from sort of the colloquial use of, but I'm sort of, as you're talking and describing this, I'm thinking if they don't understand the difference in what you're describing versus uh, you know, um uh what looks like, how we often talk about perfectionism, then they're not paying attention because, and I'm sure that they are, because I think it's it's palpable sort of the this fundamental perception of oneself and oneself in relation to the world and others that this is not just boy, they need the kitchen to be clean all the time, like this is much more yet it's not an obsessionalism.

It's it's it's it's not that.

It's it's a much deeper it it's a much deeper um it's a much deeper creative way of trying to deal with feeling totally defective and feeling unacceptable to the world and it's a strategy with the promise of a if I can only be perfect, then there's the promise of good things happening or the promise of horrifically bad things not happening.

And when you work with patients and you kind of tie back to where where it originated very often as children, and that's often where you get the real depth of the pain, um you get an appreciation, you help the patient get an appreciation of what an elegant tragic, but elegant solution to a problem, a childlike solution to trying to feel good enough in the world, a solution would be if I'm perfect.

And you think, well, you did the job of a child, you tried to solve the problem of what you of who you believed you were or what you believed you were and you you worked at it you continued you tried to solve the problem.

It just didn't work. And so to take away any sort of sense of that they did something wrong in all of this by becoming perfectionistic or the consequences of the perfection of depression is suicide.

No, that this was a this was a this was a an an elegant solution to the problem, but it's's a solution based on a a childlike perspective of the way the world works. Um and then help helping the person to kind of get to look at it with adult eyes, if you like, and sort of say, okay, well let's talk where we can go from here.

What are some other ways we can do?

Uh to to try to try to resolve this.

So let's let's uh dive into it.

Do you want to give us a sort of a 30,000?

I mean, I think you've been, uh the listeners sort of has a good sense of like where we're going in terms of like the treatment work the the treatment that you've been working on for the last several decades.

But uh well, I as it comes from a psychodynamic perspective in the first and foremost, um a gain, which is so fundamental to psychoanalytic and psychodynamic therapy, is the establishment of a a safe caring therapeutic alliance where you work with the person not only to feel, uh, you know, like there's a good connection with the therapist, but there's both safety in that therapeutic alliance, and there's um trust in the therapist that they're going to be helpful. Um and you need both both pieces. Uh and so a good deal of the work, especially early on, but throughout the course of therapy is the establishment and the maintenance of of that kind of environment for the person to be able to take some of these some of the risks that they need to take.

So, um in in the treatment, um, I'm try to give a very quick synopsis of it.

I mean let me because I think that and then we can sort of just get in there.

But I think something you said that I think is important.

I think to an extent in our training and our talk like the saying that the therapeutic alliance is, you know, necessary or important or whatever has almost become cliché.

Yes, it has.

That yeah.

Okay.

Okay.

And uh, I don't know if that but it seems like in your framing that there's something, um, and you there are subtexts that you alluded to this, but I think it's, again, it's worth commenting on because it's become cliché, but it's not cliché.

It's it's extremely important because in this context, I mean, I'm imagining a client who believes they need to be perfect or they believe everybody else needs to see me as perfect.

And as the therapist, you're one of everybody else.

So then so that relationship, particularly that that that trusts bond if you want, uh that that is that's necessary because if if you don't have that, then I is the person who believes that you need to see me.

Like I won't be vulnerable.

I won't let you you're everybody else.

Yeah, that's the concept of transference.

Right.

And so in in this treatment.

That's arap on part one of my conversation with Dr. Paul Hewitt.

As I noted at the top of the show, you can check us out on YouTube, links are in the show notes.

Until next time.

Broadcasting the world I' Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia.

Welcome to episode number 23 of psychotherapy and applied psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights, pull back the curtain, and hopefully have some fun along the way.

If you didn't already know, you can check us out on YouTube. Just tap the link in the show notes, and while you're there, be sure to hit the like and subscribe buttons.

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Today I couldn't be more excited to welcome, who I would argue is literally the world's authority on perfectionism.

My guest is a professor of clinical psychology here at the University of British Columbia.

He's a fellow of the Canadian psychological association.

He won the Heb award for distinguished contributions to psychology as a science, was cited as one of the top 10 Canadian.