Understanding Perfectionism

Striving to achieve your goals and ambitions can be satisfying and help you grow as an individual, but it can also become a problem. If you set demanding standards for yourself (such as how you should behave, or how much you should achieve), there’s a risk you won’t meet them. If you base your self-worth on achieving those standards, or if trying to meet them causes you a lot of trouble, you may be struggling with perfectionism. By itself, perfectionism can be a serious problem, but it can also contribute to other mental health difficulties, including anxiety, depression, and eating disorders. The good news is that cognitive behavioral therapy (CBT) is an effective psychological treatment for perfectionism. This guide will help you to understand:

• What perfectionism is.
• Why perfectionism might not get better by itself.
• Treatments for perfectionism.

• Scaffold knowledge. The guides are perfect during early stages of therapy to help your clients understand how their symptoms fit together and make sense.
• Reassure and encourage optimism. Many clients find it hugely reassuring to know there is a name for what they are experiencing, and that there are evidence-based psychological models and treatments specifically designed to help.
• De-mystify the therapy process. To increase your client’s knowledge of the therapy process and the ingredients that it is likely to involve. If you can help your clients to understand why an intervention is important (think exposure!) it can help encourage them to engage.
• Signposting. If you’re just seeing a client briefly for assessment, or you have a curious client who wants to know more, these resources can be a helpful part of guiding them to the right service.
• Waiting time not wasted time. When you’ve assessed someone but their treatment can’t begin right away, psychoeducation can help them learn about how therapy can help while they’re waiting.

• Case examples to help your clients relate to the condition, and to normalize their experiences.
• Jargon-free descriptions of symptoms, and descriptions of how they might affect your thoughts, feelings, and actions.
• A symptom questionnaire for screening assessment.
• An accessible cognitive-behavioral account of what keeps the problem going, or what stops it from getting better.
• A description of evidence-based treatments for that condition, including an overview of the ‘ingredients’ of a good cognitive behavioral approach.

• Smith, M. M., Hewitt, P. L., Sherry, S. B., Flett, L. G., & Ray, C. (2022). Parenting behaviors and trait perfectionism: A meta-analytic test of the social expectations and social learning models. Journal of Research in Personality, 96, 104180.
• Maloney, G. K., Egan, S. J., Kane, R. T., & Rees, C. (2014). An etiological model of perfectionism. PloS one, 9, e94757,
• Strickier, J., Buecker, S., Schnieder, M., & Preckel, F. (2019). Multidimensional perfectionism and the Big Five personality traits: A meta-analysis. European Journal of Personality, 33, 176-196. 
• Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology, 73, 1301-1326. 
• Smith, M. M., Sherry, S. B., Ray, C., Hewitt, P. L., & Flett, G. L. (2021). Is perfectionism a vulnerability factor for depressive symptoms, a complication of depressive symptoms, or both? A meta-analytic test of 67 longitudinal studies. Clinical Psychology Review, 84, 101982.
• Lloyd, S., Schmidt, U., Khondoker, M., & Tchanturia, K. (2015). Can psychological interventions reduce perfectionism? A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 43, 705-731.
• Suh, H., Sohn, H., Kim, T., & Lee, D. G. (2019). A review and meta-analysis of perfectionism interventions: Comparing face-to-face with online modalities. Journal of Counseling Psychology, 66, 473.
• Shafran, R., Cooper, Z., & Fairburn, C. (2002). Clinical perfectionism: A cognitive behavioural analysis. Behaviour Research and Therapy, 40, 773-791. 
• Shafran, R., Egan, S. J., & Wade, T. (2010). Overcoming perfectionism: A self-help guide using cognitive-behavioural techniques. Constable and Robinson.
• Galloway, R., Watson, H., Greene, D., Shafran, R., & Egan, S. J. (2022). The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 51, 170-184.
• Robinson, K., & Wade, T. D. (2021). Perfectionism interventions targeting disordered eating: A systematic review and meta‐analysis. International Journal of Eating Disorders, 54, 473-487.
• Egan, S. J., Wade, T. D., Shafran, R., & Antony, M. M. (2014). Cognitive behavioral treatment of perfectionism. Guilford Press.