The Psychology of Perfectionism: The struggle to be good enough with Dr. Paul Hewitt Part 2

Join Dan and returning guest, Dr. Paul Hewitt, and continue deeper into the psychology of perfectionism.

Dr. 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.

In part 2, Dan and Dr. Hewitt explore the complexities of perfectionism in therapy, emphasizing the importance of vulnerability and the therapeutic alliance. They discuss how perfectionism often stems from unmet relational needs and the emotional pain associated with it. Then, Dr. Hewitt elaborates on the effectiveness of group therapy for perfectionistic individuals and critiques the limitations of cognitive behavioural therapy in addressing deeper relational issues. They finish by discussing the emerging research on perfectionism in children and the need for a more nuanced understanding of psychological constructs beyond traditional DSM categories.

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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Chapters

• 1:25 Defining Perfectionism and Vulnerability in Therapy
• 3:50 Creating a Therapeutic Alliance for Perfectionist Clients
• 6:15 Exploring Psychodynamic Approaches vs. CBT for Perfectionism
• 10:30 Addressing Relational Needs in Perfectionistic Clients
• 14:10 Understanding Early Life Patterns and Their Effects on Perfectionism
• 20:50 Benefits of Group Therapy for Perfectionism
• 27:30 Experiential Learning and Therapy’s Role in Behavior Change
• 32:10 Other-Oriented Perfectionism: Clinical Considerations
• 36:20 Critiques of CBT for Perfectionism
• 41:30 Examining Relational Needs as Drivers of Perfectionism
• 51:00 The Limits of DSM Diagnoses in Addressing Perfectionism

Transcript

Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia.

Welcome to episode number 24 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.

And if you didn't know, we're also in YouTube, just follow the link in the show notes to watch, hitting the like and subscribe buttons on YouTube and following the show in your podcast app keeps you updated and it helps to spread the word about the show.

On today's episode, I couldn't be more excited to welcome back a true authority on perfectionism.

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

He won the Hebb award for distinguished contributions to psychology and is a fellow of the Canadian psychological association.

He has also written and co-written several books and has a website full of great resources, all of which I link two in the show notes.

In part two of our conversation, we dive deep into the treatment of perfectionism, discussing individual and group approaches, the process of change, CBT versus psychodynamic approaches, perfectionism in children and much more.

This episode starts with my guest talking about the importance of creating therapeutic environments where perfectionist patients are willing to be imperfect.

So without further ado, it's my pleasure to welcome back Dr. Paul Hewitt.

We're asking patients in the therapy to do something that they've been terrified to do throughout their life, which is, embrace being imperfect, try, you know, a presenters, disclose things about imperfections, present yourself as a vulnerable person to the therapist.

So the the metaphor I use is that um well, in order for that person to feel safe in the world, feeling flawed and defective, the way to feel safe in the world is by trying to be perfect or trying to appear to others as if they're perfect.

So showing themselves or allowing themselves to be imperfect is incredibly dangerous.

That that's the feeling they have.

That's what vulnerability is.

So if you think about some any of us going through it, we have learned all kinds of things on how to feel safe in the world.

So you probably only had to touch a red hot element once and even then you may not have had to learn to touch at once. Maybe you observed some somebody else touching it, and so the eye so following that you will spend a lifetime of when you see that red hot element You're going to keep your hands away from it, and it's going to work wonderfully because you're not going to get burned, you're not going to feel the pain of that.

Well, if I come to you and say Dan, I'm going to take your hand and you're going to we're going to go into my kitchen and I'm going to turn the element on and I have to I'm I it's going to be okay.

I'm going to set your hand on there and you're not going to feel any pain.

You're going to say I'm out of here and it's that kind of task that we're trying to do with these folks is trying to create a situation in a context where the person might consider based on the relationship with that other maybe I can trust maybe I can trust in something different than I have believed all my life different than the behaviors I' exhibited all my life and so that constitutes a therapeutic alliance to me is to create that kind of safety for the individual that they can do things that they have been avoiding they've been terrified to do throughout their life and so you're absolutely I agree with you hundred percent that it's become so cliché when you say therapeutic alliance.

But for me, that's what that's the kind of connection that I'm talking with.

So deep trust in the therapist, a connection, the patient has a sense that I matter that to the therapist that the therapist has a real genuine legitimate interest in me and in trying to be helpful to me, so the Rogan pieces absolutely, but that epistemic trust as well that some of the um some of the psychoanalytic folks talk about as well, that that that's the context to learn these new behaviors in.

Right. That it is it is only within that context that the corrective experience can occur, that I can that that right.

And then, and this is I so you know, I wasn't really trained in any sort of dynamics sort of framework, but this is something I've definitely taken from, which is that the dynamic folks are so like, I think this is something that many people from other orientations, I'm particularly made more cognitive behavioral sorts of orientations, um, that the value of bring it into the session, right?

So like that you can, right, we can use this here and now to process and to like this.

I I mean, it's such a one, I mean it's um it's so available, you know, that like you I I can use me and us to make this um treatment work, that this in this relationship and uh anyway, yeah, that um, but and obviously there are lots of cognitive behavioral folks who do integrate some of that.

But I think that the dynamic folks in like they do, they're much more overt and, yeah, and and have, you know, decades of, um, uh, uh experience and thinking and practice doing these sorts of things.

I think and refinement.

I mean, I like that you said decades because that orientation has been under attack for a hundred years, but it's still one of the most common or theoretical orientation therapeutic orientations that people have, and it's there's also a credible amount of research that within that domain of of psychoanalytic theory, psychodynamic therapy, um that people often are totally unaware of, and they're told there's no research, but there's a massive amount.

But there's also been 100 years of refinement of thinking about of shifting and changing and and seeing what works in treatment and the subtle changes that occur.

So yeah, there's a a rich history uh of that kind of work, um that really bears on being effective for people.

And there's a good deal of research that suggests that it is, uh just as effective as any of the other treatments that are out there.

Well, and I think that the, you know, in listening to you talk that the, you know, I think that if you're a thoughtful, sort of flexible person from a from almost any other orientation, you can take everything that you're saying.

Like I feel like this is not, you know, because you're in that tribe, we can't fit you know that this is, um, yeah, everything that you're saying, I'm sort of taking my own jargon in my head and plugging it into your the clauses that you're using to be like, oh, well, this is it, this is that.

And uh, that I think it's that the good clinicians in the real world, this is not new.

When you work with people every day and where they're struggling through their difficulties, psychotherapists, good psychotherapists learn from this, and so when somebody like me talks this way from a psychoanalytic perspective or psych like you said, they just say yeah, yeah, I see that.

It's in academia in the academy, where people don't work every day with people in patience, that it gets polarized and there's this misrepresentation of what it is and these kind of wars sort of exist.

But I I would agree.

I mean, there's some research that suggests that the seasoned therapists, irrespective of their orientation, have way more in common in what they do than the beginning therapists coming out of the academy, if you like that they're really different in terms of what they do, but over years as you learn how to actually do the work with people, we all kind of become very similar might do different things, but we we think about people very similarly. So yeah, I'll be curious.

I don't have any data on this, but I have felt like since when I started training until now that there's been a shift where there's been less sort of tribalism in the different orientations and approaches than there used to be.

Do you get that sense or my is that just, do you feel like that or not too much?

In the clinical world, I feel that in the academic world, though.

Okay, interesting.

I think it's still there.

It's it's a little bit more subtle. , but it's still there.

I see it uh with my colleagues.

It's subtle.

I actually started with my students and other students who have real interest in being trained psychodynamically. At in my program, I've started a group because students would come to me and say they feel marginalized, uh because they'll talk about things in a in a slightly different way and they'll feel marginalized.

And what would happen is I decided it's not a support group, per se, but it's a group to be able to remind these students who are doing my practicum in another psychodynamic person's practicum that the way you're thinking is fine, it's very different.

It's very potentially threatening to other people or antagonistic to other people, and they have no problem voicing those things, but and just to remind them, no, that you don't come and we'll chat once a week about whatever you need to provide this sense of okay, no, the way I think about things yeah, there no, there there's legitimacy to it that I can do that.

So I I maybe there's less, um, and actually there there certainly is less in our program because we train a good number of studentsmedily in asyodynamic orientation now. But there's still elements of it that are there.

And I think across the country, for for example, in counseling and in clinical psychology, internships, I work with my students to try find internships where they're going to get additional psyodynamic training, and not just focused on CBT or DDT, a cognitive behavior therapy or dialectic dialectical behavior therapy, and we have to kind of work at it.

Interesting.

Okay, so let's let's so yeah, no uh I took us off.

The so in getting into the treatment stuff, so two potential questions or you can take it whoever you want.

So one is I'd be curious to hear your thoughts because you've done work at both the individual and the group level in terms of and then you've and then you also talked about earlier and I think it's worth talking about sort of transf and counterransference.

So we could take one of those two avenues into it or third, if you have another way you'd want to go.

Well, let me just talk broadly about the whole theoretical approach to doing therapy.

I I've sort of alluded to these two driving motivational forth that that need for esteem or cohesion and a need to belong.

So the idea here is that um when we're working with perfectionistic people, we don't do diagnostic work.

We do clinical formulation.

So we want to create a model of each individual, and each person has a completely unique and idiosyncratic model about a function. And how perfectionism plays a role in their life.

So one of the things we want to address is, um within this model is, what are the relational needs that are not being met for the individual?

And really we're talking about usually, especially with perfection is, this need for for self esteem or self cohesion, and a need to fit and belong in the world.

And so we want to understand those relational needs.

We want to understand the types of when those needs aren't met.

What is the person experience effectively or emotionally?

And that's the pain piece of this and everybody will first say depression anxiety is what they experience.

But when you dig into the depression and anxiety, you very often get to a painful affect reflecting.

I'm not being good enough.

I'm alone, I'm disconnected.

I'm isolated from the world.

I'm reprehensible.

I'm, you know, uh we get to those relational pieces and the pain connected with that.

So we have the needs that are not being expressed, we have the affect, and then with that affect we try to handle, we try to cope with that affect somehow.

And these folks have c coped with the affect that well, if I'm perfect, that'll reduce the affect, but if I'm perfect it will also meet the needs.

So we work from these triangles.

I again, I'm like it's hard to describe them verbally without without slides and that sort of thing.

But the idea is I will have these relational needs that are not being met.

I don't fit, I don't belong in the world, and that is deeply painful to me.

In order to deal with the pain I need to do something, and so if I have the sense that if well, if I'm perfect, then I'll meet those needs I'll fit and belong and it will take away the pain. .

So at a real basic level we're trying to create a model that's um you know with the person's own life in terms of those needs and the affects and how they are trying to be perfect or appear to be perfect, as well as these other things that people will do because they're complex. Um And so there's these the two these two triangles that we put together and describe.

So there's that's how the person functions internally.

These needs aren't being met painful affect, and then the perfectionism serves the purpose of reducing the affect and the promise of meeting the needs.

We also look interpersonally in the person's world, so we look for interpersonal patterns that the individual has, and these usually arise from early early relationships where the person learns, you know, in order to feel like I feel in my family, I will need to be the perfect caregiver.

I will need to actually be the perfect parent to my parents who are useless, or I will need to be perfectly invisible, and so they have these patterns that they learn to try to cope with their their early life, and those patterns show up not only in their past relationships, but also in their current relationships.

So um you'll see a pattern that that uh you're trying to identify patterns that where they're early in the person's life that show up again in their relationships with their workmates, their romantic partners, their friends. And and we try to identify those patterns with the assumption then that those patterns are going to show up in the therapy.

They're going to show up with the therapist.

So if the person needed to be you know the perfect uh student early in their life in their family that that was the way to create safety.

It was a way to create a sense of a promise of affection or love or mattering.

Then you're going to see in their current relationships, you know, at school or at work, they're going to be the perfect worker.

They're going to be the perfect student in that context to create safety and to create a sense of okay, I matter, I'm good enough, I'm belong. And then in the therapy, you're also going to see trying to be the perfect patient, trying to exhibit the same kinds of things in the here and now the therapeutic alliance.

And and so the so these interpersonal patterns, these are things that I do to uh, in response to the pain to in an attempt to get my needs met.

Well, in response to the pain and in order to try to get the needs met, yeah, the volume to turn down the pain first off, but also with the promise of meeting these needs. Serves purposes.

And that is exhibited in early relationships doing uh, you know, the perfectionism that that trying to meet the needs in a particular way, you'll see them in current relationships, and then you'll see them in the therapeutic uh in the therapy itself with the therapist.

So that would be the transference that would be so you work the real work of therapy in this is in the here and now, and you you alluded to that earlier that when those emotions are right in the room with you, then you can actually work with it's not an abstract working.

It's it's a working right here and now with that.

And as we alluded to earlier, the interpersonal patterns, those things that I'm doing, they don't actually work.

No, they don't.

No, they they really don't.

And it's it's kind of like the way the way we understand it is if I've learned that if I come across to you is absolutely perfect, that the model I have is, if I come across to you as flawless and perfect, then you will care for me. Then you will like me then you know I will matter to you until you actually start to interact with me, and I'm not disclosing anything too personal or ah imperfect in any way, so I'm pretty distant.

I'm not demonstrating anything to you against I'm pretty distant. And how do you when you and I interact and you're interacting with me being very distant eventually you're just going to pull away.

So here I am trying to appear perfect in with the model that you're going to care for me, and the more I do it the more you're pushed away or I can also tell you how wonderful and perfect I am and not let you get a word in edgewise because there's one more thing that I'm perfect out that I need to tell you about and this is a model of what, then you will respect me, then you'll care for me, then you'll think I'm amazing.

And what do you actually feel?

Yeah, yeah, I'm I'm annoyed.

I get away from me. Um and and that's that's the model.

That's the neurotic paradox, that I am driven to to obtain a goal from you by engaging in this behavior with the absolute belief that if I do this, you will care for me, but I actually create the thing I fear the most, which is your rejection or your pulling away your distancing.

Yeah.

What would it make sense to jump into your thinking about group for folks of perfectionism?

Yeah, um What we do that we do group work and we've done most of the research we've done is on is on within groups. Um A group is uh psycho psychodynamic psychotherapy within groups.

It's psychodynamic, interpersonal psychotherapy within groups. Um It I'm really sort of feeling like it might be the treatment of choice, actually for perfectionistic individuals because of those those powerful relational needs.

Now it is often terrifying for perfectionistic people to think about going into a group to do therapy and it's pretty anxiety provoking for for those folks.

Intriguingly, once they start, um they folks will talk about.

It's the first time that they've ever had other people who, one they see is similar to themselves and really can understand what they're actually going through.

And so they actually, for some of the first times in their lives, feel a part of a cohesive cohesive group. Um and so it's very, very powerful that way, but at the same time in the kind of work that we do, it's all based on the same sort of theoretical model.

We want to get to the relational needs that are being uh expressed or requested or invited by people in the group, get them to articulate the needs, and they'll get feedback from other members about, while with you know, you you want to come across and you want to be accepted into this group, but all you talk about are your straight A pluses in school or all the wards you meet, and that's dis that distance is ever so they get this very powerful feedback from these other people in a context that is safe because we spend a great deal of time making it a safe support of context for people to be vulnerable, but get this kind of feedback from these other people.

So we're I mean, the research that we've done with the group throws very good effects on on changing perfectionism as well as a lot of symptoms and other problems that people have.

And um it's um the more we kind of look at it and do it, the more I'm thinking that it absolutely is uh potentially the treatment of choice, but certainly a a powerful treatment for perfectionism, um and may be a nice adjunct to individual psychotherapy that we do with perfectionism as well.

So is it reasonable that whether it's group or individual, that you that you would have to spend a substantial amount of time oh, just throughout trying to facilitate helping clients see how unhelpful this is, how they're not.

It's not having the effect.

It in fact, it's often having the opposite effect. And it's not it's not because you're flawed and defective that people are pulling away from you.

It's that the way you're dealing with feeling like you're flawed and affected that people are pulling away from you.

Does that does that make sense?

Yeah, no, it totally makes sense.

I'm thinking about what I'm thinking about is you're describing this is just how, I mean, just rolling a boulder up a hill, how like I'm thinking about if I like the actual person, right?

I'm thinking about an actual human being who I'm coming in who's coming in and I'm talking to.

And so that I have to create that I need to create this safe context and I need to most likely, you tell me you correct me, but you would have to really kind of, you know, you you've been very direct in our conversation and I've said, oh yeah, that makes sense.

Oh yeah, that makes sense.

Oh yeah, that makes sense.

But when you're actually working with a real human being who's suffering with these, you know, these challenges that there you you probably aren't that direct, because if you were, it wouldn't be helpful and that it's just how trying to shift, I mean, even just trying to get them to see and feel oh yeah, like that that is how challenging that would be.

Um, yeah, it is it is challenging.

It it's hard work uh with people.

The the metaphor I use I like that you said you can't just tell somebody something and then they're going to change their behavior, their change aspects of their personality.

I I liken it.

I wrote about this in a book.

It took me a long time to kind of figure this out, but I I liken this kind of psychotherapy to learning how to ride a bicycle.

And if you've never ridden a two wheeler, Dan, and you decide today's the day I'm going to get a ride learn to do this and you being a a talented academic, very intellectual, you say, I'm going to hire a Lance Armstrong under why I thought of him, but anyway, Lance Armstrong to come and do a workshop, he's going to do a lecture, he'll have slides, ah, he'll talk all day long and teach us about while you put this foot there, you put that one there, you'd contract this muscle and so on, and you'd learn all this stuff and you study and you write the multiple choice exam, you get a hundred percent and you know it flat.

And then you go out and you get on the two wheeler and you fall over.

The the way to learn to ride a two wheeler is actually interpersonally, most typically.

You have somebody else who's there, holding the bike, you get on, they encourage, they help, they push, they guide you, they let go, they grab on again, you're wobbling, you're getting, you know, you fall down, you get hurt, you get back up. And eventually through the process of experiential learning, through experience, you progress through falling over the moment you sit on the bike to navigating through traffic, watching signs, being aware of other drivers, of being aware of the cow in the field as you to doing this incredibly complex thing that you can never learn by studying it by the intellectual avenue.

It's the experi piece, so the teaching and the learning is within that therapeutic alliance to have the experience of being able to do things that they've not been able to do before and experience that there was not this calamity that it the world didn't fall apart.

I didn't crumble.

I made it through. And so that experienal element is it's sort of the best way I have of trying to explain how it is that people learn in a in a more podynamically oriented therapy.

In group, do you think that clients by seeing this in other people are able to in the group, are by seeing it in other people in the group, do you think they're able to make sense of it more quickly, more effectively in themselves?

I think what they'll do is they'll see the effect.

They'll see the effect of what that person is doing.

The negative like the consequences on themselves.

I'm sorry, let me say it a different way.

I think you're right.

That seeing other people take those risks, they may learn about themselves as well that that they have that, and they may just by seeing a person take a risk, they may think, okay, well maybe I can do it.

I think what's more powerful is when that other person takes a risk and they see the effect of on the group of what happens is people, I mean, one of the things that is lovely to see in patience, especially patients who have the belief that if I really let people see who I am, they'll run screaming from the room so I can't reveal who I truly am to anybody because it's just too terrifying.

I'm sure you've had patience like that, and then when they help them get to a place where they they actually do that, they discover oh my God, when I do that, I just get closer to people that is that that's a moment that I think is hugely powerful uh for those folks.

And in group, you can kind of you can kind of see that our.

No, of course you can't. You you have to teach people that they have to vet who they're going to disclose to.

Right, right, right, right, right, right.

But if in that context it's if they can be more that they can do things they've never done before that are so terrifying and see that the effect is oh, that's how I get closer to people that's how I matter to others.

Not by being perfect and standoffish.

It's about maybe being more genuine or more authentic. Is other oriented perfectionism?

Is do you think that do you do you now, obviously you said that you you would do a like a case specific conceptualization.

So each client, each make is their own conceptualization, that makes sense.

So there there's obviously you're allowing for the nuance of the individual to be playing in here. Um of course, of all that, right?

And so uh and do you, when you think about um other oriented perfectionism versus, uh, you know, the other sort of two sort of trait level, do you do you think about it differently in terms of what you need to do clinically or not so much?

Not so much because I'm looking underneath.

But what are the relational needs that are not being met and how are they trying to meet them?

Now I may I guess there may be some the content of what we may talk about might be slightly different for somebody who's more other oriented than socially prescribed yourself- oriented.

But it's it's really working at that relational level in terms of what they're doing to try to meet those needs, the lack the lack of the meeting of those needs of feeling okay and good enough, and that what's important about the drive?

What are you trying to do um by engaging in all these behaviors?

And what are some other ways to meet those needs?

So it's kind it's kind of to help them articulate what the needs are that they're that they don't have and the pain of all that, and then helping them move to a place where there's maybe more adaptive ways to try to to try to meet them.

As I said by you know, doing some things they've not been able to do, which is maybe disclose a little bit more of themselves or take risks and showing themselves to be authentically who they are, um that that has the opposite effect of what the of the model they've been working with all they are.

So one of the things that I was wondering about before, when I was thinking about this conversation was I know that there are some CBT folks who do perfectionism focused uh intervention stuff.

And I was sort of curious what your sort of sense of that is, how it relates to your work, you know, like Sure.

Yeah.

Yeah, there are some some people who have done um um who who conceptualize perfectionism quite a bit differently than we do, uh first off, and then use us conceptualize it as a cognitive primarily a cognitive or attitudinal kind of variable, and then appropriately, if that's what you conceive of it, it makes sense that a cognitive behavioral therapy approach might be helpful.

And um yeah, there's people who have done some research on that and done a variety of of uh studies looking at what what they call it they call it CBT, but the way they define CBT can be like a a protocol kind of similar to the way back talked about it originally, but then other things like read a book, um read a book, do some psychoeducational stuff for calling all of that CBT. And they they presented some research and did some metanalytic work, um which was fine.

I thought this is great.

There there's a group of people interested in trying to be helpful to these folks who are really hurting.

But as we began to do more of the randomized control trials and some of the other uh psychotherapy outcome work uh in the psychodynamic approach looked very carefully at that work.

And there was a met analysis that they' published and we thought, oh, well, they forgot to do a couple of things, But what we'll do is sort of a fundamental thing that you do in science is simply replicate.

So we took all the studies that they use in the met analysis and we reanalyzed them.

And what we found was a a less than optimistic picture of of what they were doing in terms of CBT.

So in most importantly was there are certain elements of perfectionism that are particularly pernicious.

And so we talked a little bit about other oriented.

You saw that, but also socially prescribed perfectionism is really pernicious in terms of about depression anxiety, but a bunch of different things, including early deaths, by the way, uh but suicide.

And we found when we replicated uh this this this CBT for perfectionism work that it didn't have any effect on the pernicious elements of perfectionism did change some of the cognitive stuff, which just made made sense to me if you focus on the cognition, but it didn't change the traits and it didn't change the perfectionistic self presentational elements, um which we thought was on the one hand, um really important to put out in the literature that, you know, this is not touching those important pieces.

But then as we looked a little bit closer, we also saw that often 50% or more of the people who were enrolled in those programs dropped out.

And so we thought, well, okay, it's I mean, it has an effect on the cognitionence for some people who stay in therapy, but if 50% of them drop out, then maybe you need to do some other pieces in in terms of the treatment.

And so there are a variety of things that just, you know, it was less optimistic than I think was being presented. Um and and again, um it um there was a little bit of pushback from that group, which is fine.

It's just the way it works.

But but one of the accususations was this is they were saying it's this is how bad science produces effects.

And we thought that that's very funny because replication is a fundamental pillar of science, and to complain that we replicated used exactly the same data they used and replicated found some things that they forgot to either address or focus on or even report. Um you know, there's that sort of piece that sort of fits in there.

So in the now it's not to say that the treatment that we've developed is uh is perfect or anything like that.

But what we did do is, um we have been able to demonstrate that it does change, uh effectively the pernicious elements as well as the cognitive elements, but it's not perfect.

And so the research we're doing is not to say we have this treatment and we're going to do all this research to say it's excellent.

We're doing the research to say, okay, this works.

This doesn't work as well.

What can we do to shift and change the treatment so that we're getting better effects in some of the things that don't worked as well.

So we're looking at it less as research to demonstrate that the treatment we've developed works and research more on okay, well, what works and what doesn't work so and how can we try to make it better?

So to be a series of outcome studies that we're doing while we're tinkering with with the treatment of trying to make it trying to make it better in different ways.

And that's with your dynamic treatment.

Yeah, it's called dynamic relational therapy.

It's it's um a a psychodynamic approach.

I sort of spelled it out today in terms of some of the things that we do with.

And is your sense?

I mean, we're just guessing here, but like is your sense of maybe why some of that's the CBT-based intervention wasn't as effective in terms of the pernicious stuff, because it wasn't I mean, in a way, it sounds like it wasn't focusing as much on those sort of uh or traits or personality-like kind of aspects of the patients.

I think it's because they didn't deal with the relational, the deeper relational motivational variables, because the CBT by in and of itself deals with the surface stuff about thoughts and cognitions that they will talk about affect, but they don't really go very deep with AI.

It's more about the corrective thoughts or correcting.

The scary part is with that and other parts of CBT is sometimes it's directed more at coping with perfectionism, or more broadly, like you've seen advertisements all over the campus in different places learn how to cope with your depression, cope with your anxiety, and it drives it drives me crazy and my students always laugh because they see me, you know, I want to rip they say, why on earth would you treat use all these incredibly complex, psychological interventions?

Why would you use people who have been trained extensively in the psychological interventions just to help somebody cope with the Why aren't you working with what's causing that so they don't experience a depression again?

Why don't you work on the psychological causes of the depression or the anxiety or the perfectionism?

So it again, now this is it's just reflects a psychodnamic way of thinking about problems that if you're if all you're going to do is treat the symptoms of something and try to reduce the symptoms, you're not being very helpful to people.

It's like if you have a exceedingly a distressing pain in your knee, hopefully when you go to your physician, you don't simply get pain medication to take the symptom away.

Yes, it will be relieving the pain's not there, but the whole point of the pain is it's it's a communication to you that there's something wrong in your knee Pay attention what's going on with the knee.

Now a physician won't just give you pain.

They're going to poke around in your knee and try to figure out what's causing the pain and what are they going to treat?

Well, they might give you some relief with pain, but they're really going to treat the cause of the pain, so in these interventions that help you cope with that that's why it drives me nuts.

And so so is it this is a let me do an extremely precise um uh summary of what some of what you just said, which is because this comes from interpersonal uh, because this comes from the interpersonal.

If we can attend to the interpersonal in therapy um and influence that we're able to attend to the the cause, the the that wasn't that wasn't gracious at all.

But, you know, uh, the putative cause in this in what we're talking about today, the putterative cause of the existence of the perfectionistic behavior, which results in really, you know, all of the depression anxiety, suicide all the negative impact of that.

But if you try to get at the cause of the perfectionism, it's like pain.

Right.

But the the cause is interpersonal.

Well, the cause is relational and its motivation.ational motivational a need.

I have a need to feel like I'm okay that I'm good enough in the world.

I have a need to feel connected to other people.

I have a need to feel loved to to love.

I have a need to be lovable. And it's those needs those the fact that those are not being met from our theoretical perspective, it's that's what's causing the existence of the perfectionism, and then with the perfectionism comes all these other problems.

So if you get at the cause of the perfectionism, you get at meeting those needs in a different way, the person there's no need to be perfectionistic any more.

That that's the model.

It's like if I fix the problem in your knee, the pain's going to go away on its own.

Right.

Yeah, no, that may.

So, um, I'm trying to think about where okay, so let's do this.

And then if there's anything I'm missing, please jump in.

But one thing I did want to ask you, because I I know that you you don't do work with kids, right?

I have a new graduate student who that's exactly what we're starting to do is is take that treatment to work with kids and adolescents.

So the question I was going to ask you, because I wanted to ask you about resources and then what I'll do is I'll take notes of resources, and then I'll put them in the show notes.

So if anybody.

But one of the things that I was wondering is, even though your work historically has primarily not been with kids, you must get parents who approach you who say, my kid is, and, you know, it might not be what you, you know, were hesitant to categorize somebody as, you know, a a kid as a perfectionist.

But we certainly could say that certainly certain kids have these that would have would show some indications of perfectionistic traits that are consistent with this framework or this framing.

Yeah, there's a lot of there's a lot of research on perfectionism in kids.

We just we just published a book last last year, summarizing that some of that work and summarizing some of our some of the bases of the models that we might use to treat perfectionism.

Okay, so what so what's the book and I'm just because I think that there's probably going to be people there's going to be a listener who's going to say like I could really use looking at a resource or two for this.

Do you want me to hold up my books?

That'd be great. Uh but uh well, this one outlines a lot of the sorry, the stuff that I've been now for some reason I have a mere image of it on my on my.

It's just it's a 2017 book on perfection.

Con talks about everything we talked about today, uh more in depth. But um my colleague Gord Fett and I have just we just published this last year, uh am I hear perfectionism in childhood and adolescence.

And so review it's less the first book is more of a clinical book.

This is more of a not not so clinical book, but a lot of the research that's that's on there as well.

I'm happy to send you those references if you want to.

I I will look if I, for some reason I can't find them, which I can't imagine.

But what I'll do is I will look them up and I will hyperlink them so that way if people are listening, they can just click on it and go, um they're on my website as well.

It's easy to find my lab website I will link that as well in the show notes.

And are there one of the other questions I wanted to ask you was, um, particularly because we're going to have practitioners or practitioners in training who are listening that you develop several measures and and like what would be, you know, what would be the ones that you would point um that you tend to point clinicians to?

Well, the measures that we use for those three broad domains, the traits of the self-presentational elements and then the introersonal elements. Um it those are available on my website with the exception of one, which is a multihealth system zones, uh the one of the trade measures. Um But but if it's on, they can just go to my website that says measures and they can see, and I provide norms and I provide that other than the MPS, I provide the measures themselves, outult versions and children, versions for kids as well.

And you have you have self-report measures and you also have clinical interviews, right?

I have an interview.

Yeah.

We've used it less.

The self-report measures tend to be used a lot more frequently.

Okay.

Okay.

Great. Um before before we we end, is there anything else that you want to make sure that we hit?

This has been I feel like this has been a lot and I think that even in there are like there are other avenues, but I'm like, no, no, no, I've kept you for long enough.

Um I mean, I've been doing this for forever. 40 years, so there's there's a lot of things I could talk about in that domain.

I I mean, I guess, I mean, one of the whenever I talk about this, it usually resonates with people either personally, you know, there's bits of it that make sense to themselves or loved ones, but also clinicians.

Often clinicians will hear this and they'll go, oh, I recognize that.

I just never I never thought about it in that way or never put it in that context.

And so, um each each time I I do these sorts of any sort of presentations, people do resonate with it and it kind of makes makes a great deal of sense to them.

And um I mean, there's there's there's that that piece to it that I one of the reasons that I've been doing research on it so long is because it it's intriguing as you go a little bit deeper and you just, you just see it more and more.

And it's not that every patient I see is perfectionistic, but you see elements of of these pieces in people's functioning, uh, and especially the pain that they have, really about feeling okay about themselves or feeling okay about how they fit in the world.

And so they're really foundational pieces that are that I think are are are fundamentally painful parts of of living.

And we always try to deal with those in in different ways.

And people are more or less effective in dealing with that.

A lot of the people that you and I see in our practices are people that maybe just have ways of trying to deal with those issues that are are less effective or most commonly were really effective at one point in their life and now it's not so effective anymore and but can't just stop and do something different.

So I, um I mean, that's one of the intriguing things is it's uh it does resonate with people and um, you know, there's a there's a there's a large literature on perfectionism. Um I had um great hopes as that undergraduate of publishing the first empirical study on perfectionism.

It was on perfectionism indepression, and it was my honor's thesis, and in the process of trying to publish it, another Canadian researcher at the University of Regina, published a paper on perfectionism into print, so I wasn't the first, but that's okay.

But at at that point, it's just it's kind of burgeoned now where there's thousands of articles on on uh on perfectionism and most especially the problems.

I think the uh that it's connected with with people.

So can we end on a real quick story?

Can I give you just a quick this is so you and I were at a conference that we happen to go to together and we haven to both be at Yeah, yeah, yeah.

Society for Psychotherapy research and we were both in a session and you were sitting somewhere else.

I don't even know if you know I was in there and on um, uh folks who were working on a resource, which was group like uh basically empirically supported group psychotherapy.

Do you remember this?

And, uh, which I think was a really, it seems to me like, oh, this is great endeavor to try, you know.

And um, all of the treatments were for, um, uh, DSM diagnoses for, you know, the, and you raised your hand and you you asked the question of, yeah, uh, you asked very politely. Uh which was something to the effect of, would you ever consider having a treatment or looking at treatments that aren't for um disorders, problems, challenges, whatever, that aren't in the DSM.

And they sort of said, I mean, I I I took their response as like, yeah, I guess.

I mean, you know, I didn't think it was dismissive.

I didn't think, you know, I thought the response was fine.

But when you said that, I was sort of sitting there and I had been, I've been over the last, I don't know, six months or so been paying me a little bit more, uh paying a little more attention and sort of reading up more on um more explicit critiques of the DSM and that sort of thing.

And I've always sort of put DSM in its place in my head.

That was part of my training.

It wasn't a Bible or anything.

But and one of the the things that I had read that really stuck with me is just sort of, you know, the DSM is one framework.

It's one approach.

There's nothing um , uh, you know, it wasn't handed down by God, you know, Moses didn't get it.

There's no, that that's it's it's one way of looking at things.

And when you said that, what I was thinking, when you said, I was like, yes, this is a person you who has devoted decades to studying and developing tools, you know, empirically supported, as well as clinically and supported, but in refining this um, this challenge, this very real challenge.

And uh, as far as I can tell, perfectionism, as you conceptualize it, measure it, uh, that it is no less valid than any other category in that big book being the DSM.

It is no less valid, right?

And and but it, but it goes in a different category.

And I was thinking, this is this is exactly what we want.

Like this is exactly how we should be thinking flexibly about this, which is that this is this challenge that people have, it is pernicious and it is, you know, Absolutely.

But it in the same way, it's just a different category.

I mean, it's just like we could have, you know, the perfectionism could be in a different book that would be just as valid as the DSM.

And, you know, this construct is just as valid as uh and in many more more valid than many, you know.

Anyway, I I just it's just really stuck out to me as just like it like like and this is not a critique of the people who were doing the work they were doing.

This is a larger critique of the field, which is, what the hell are we doing?

Not like, you know, really whether it's systematically not including or systematically excluding stuff like this.

And I do think there are lots of things that should be excluded.

And I'm comfortable.

I've heard people argue, oh, we should create this disorder and that.

I'm like, really?

But this We don't need more.

And but we this I just sort of it just really hit me when you said that and it stuck with me ever since of like this is the perfect example of the of one of the real problems and how we have taken and run with the DSM is that stuff like this does not get included when like we are we are not helping clinicians or clients by not including this in these and and, you know, anyway, that that's my soap box, but I just wanted to say that.

So thank you for that.

I mean, you're you're talking about something that I speak a lot about, uh which is the philosophy of a DSM approach versus like rather than focusing all of our clinical efforts on sy sets of symptoms, which are surface things, um and directing over clinical attention on the surface things, the symptoms, you need to direct your attention on the underlying causes, so that focusing on the surface is a craplinean perspective hence the dSM, the neocaplinan perspective underlying causes is actually a psychoanalytic perspective.

What are the things underneath that are producing the symptoms?

This is what Ardoc is trying so when DSM 5 came out and there was all that furrer from NIH saying, we're not going to fund DSM based disorders any more.

We're instead going to look at the underlying causes.

That was the fur and I was thinking yes, finally, we're going to deal with the thing.

We're going to deal with what's going on in the knee, not just try to get rid of the pain in the knee.

So your uh you you're you're speaking my language when you say those, sir.

And to be honest, I I mean, I I guess my I guess it was my research that probably influenced the way that I think about that.

To us, I never thought about doing the research on perfectionism from that perspective, but that is what I learned by doing the research over the years and especially doing the clinical work over the years.

It doesn't help people very much to cope with things.

We need to try to get rid of the things they're trying to cope with.

And that why why don't why don't we call it a day, ladies and gentlemen, Dr. Paul Hewitt.

That's a rap on part two of my conversation with Dr. Paul Hewitt, as I noted at the top of the show, check us out on YouTube, just tap the link in the show notes until next time.

Broadcasting.

Dan Cox, a professor of counseling psychology at the University of British Columbia.

Welcome to episode number 24 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.

And if you didn't know, we're also in YouTube, just follow the link in the show notes to watch, hitting the like and subscribe buttons on YouTube and following the show in your podcast app keeps you updated and it helps to spread the word about the show.

On today's episode, I couldn't be more excited to welcome back a true authority on perfectionism.

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

He won the Heb award for distinguished contributions to psychology and is a fellow of the Canadian psychological association.

He has also written and coritten several books and has a website full of great resources, all of which.