Modeling Healthy Self-Esteem: the Role of the Therapist in Overcoming Perfectionism

Almost every patient who comes through my door struggles with feelings of inadequacy  and its partner in crime- perfectionism. Any psychotherapist who is willing to be honest with herself will also acknowledge intermittent doubts about her therapeutic skills and effectiveness. Whereas both client and psychotherapist must come to terms with their own perfectionistic tendencies, the therapist has the responsibility to actively acknowledge and understand  her own. By taking this initiative, the therapist models self-acceptance to her clients. She communicates to the client that being imperfect is an inevitable part of the human condition and is nothing to be ashamed of. Rather than hiding behind a façade of unattainable flawlessness, the therapist, by attitude, word and deed, shows her clients that embracing one’s humanity creates the healthy soil in which we can freely grow into our best selves. If the therapist does not take the lead in this area, there can develop a tacit agreement in which only “nice” feelings are recognized and, conversely, “not nice” feelings such as anger and sadness are shunned. This type of avoidance freezes the development of openness, honesty, and trust, which are cornerstones of a good working alliance between client and therapist. Mutual back patting may give short-term satisfaction, but it cannot bring about real and lasting change.

What is perfectionism and how does it affect both client and therapist? Merriam Webster’s definition of perfectionism is “a disposition to regard anything short of perfection as unacceptable.” This definition is psychologically resonant in the way it perfectly captures the no-win situation of the perfectionist. Despite the reality that it is impossible to consistently adhere to such standards, the perfectionist exists in a state of suspended animation, waiting for some imaginary future in which she is free of the normal shortcomings, doubts and confusions, which are part of the human condition. Until this fantasied happy day comes, there can be no rest. The idea that living in a state of self-rebuke and dissatisfaction can in any way help us to succeed is irrational at best. In fact, perfectionism is not only non-productive, but it has an addictive quality, which is downright unproductive. Self-criticism is habit-forming and can be used to numb the painful feelings of inadequacy, which it both derives from and perpetuates. Just like alcohol does, the false hope of a perfect and pain-free future promises everything and delivers nothing, thus spurring the perfectionist on to ever more unrelenting self-demands. “If only I try harder,” the perfectionist imagines, “everything will be fine.” But perfectionism is a trickster and a spoiler; it insinuates itself into our experiences by feeding the fantasy of a ‘happily ever after’ existence and then proceeds to eat away at our enjoyment of life through attacks on our character. By contrast, a more balanced attitude towards self-development is based in rationality. The old adage “we can learn from our mistakes” is based in the reality of how learning actually takes place.

I want to make a distinction between the use of self-discipline in the service of achieving realistic goals and perfectionism. Whereas self-discipline is encouraging and mobilizing (“I can do it”), perfectionism is paralyzing and discouraging. People who are excessively self-critical have difficulty in acting because so often their actions are followed by self-attacks. One can liken the former to good, and the latter to poor, parenting. Imagine, for example, a child who is having a hard time completing her homework. A parent can encourage and instill healthy self-discipline by saying “we all make mistakes; the important thing is to keep trying.” Hopefully the parent will also recognize when the child is tired and needs a break. In contrast, if the parent says, “What’s the matter with you?” or “you’re not even trying,” the child falters and either stops trying altogether or buries her hurt while trying to make the parent happy. A good way to differentiate between useful self-discipline and self-attacks is to be mindful of our accompanying feelings. If we experience anger, shame, or sadness, perfectionism is probably operating. By contrast, when we can take pride in our good efforts - even if we are not successful - then we are engaging in positive self-discipline.

Perfectionism wears many disguises, but its message is always the same. The perfectionist living inside of us says, “you are not well-liked,” or “you are not good at your job and will never succeed,” or “you don’t deserve love or happiness.” Unsurprisingly, perfectionism plays a role in depression, low self-esteem, and intimacy problems. It may attack a particular action (“that sure sounded dumb”) or aspect of our ongoing experience (“I always sound like an idiot”). Most painfully, in its most intense state, perfectionism is a rejection of who we are and of our basic self worth (“I’m a loser”). Coming to terms with and eventually accepting our flaws and blunders are of crucial importance in building self -esteem. Self-esteem is a bulwark against that nagging voice which attacks us whenever we are vulnerable. When the perfectionist inside of us scolds, “you didn’t do that right and you never will,” self-esteem counters, “that’s not true, you are entitled to make a mistake and if you keep trying you can do better.”

Having explored perfectionism and its effects, I would now like to address how working with perfectionism within the therapeutic dyad (the dynamic and shifting relationship between therapist and client) can be used to bring about positive change. How should the therapist help people to build their self-acceptance? The therapist, who is the facilitator of change, needs to navigate the realm of missteps made by both the client and herself. The therapist not only guides her clients to increase their self-understanding, but she models a more forgiving attitude towards the clients’ shortcomings. This flies in the face of many people’s conception of both who the psychotherapist is and what is curative about psychotherapy. Namely, people often believe that the therapist, being herself perfect, will somehow transmit this wonderful state of perfection to them, and thereby heal them of their imperfections. This task may involve the use of a magic wand or perhaps a recital of an incantation. I propose a different way of looking at the therapeutic relationship. I believe that the psychotherapist’s task is not to impart perfection to the client but is rather to impart self-regard and self awareness. How the therapist handles her own inevitable mistakes can help to further this process.

For example, I worked with a woman, whom I will call Sarah, who became easily mortified when learning new tasks, and she reprimanded herself harshly if she made mistakes. These intense self-attacks developed in childhood, in response to parents who showed little encouragement or affection and were highly critical. She considered herself incompetent and frequently chastised herself when she did not live up to her standards of perfection. She would not cut herself any slack, regardless of such external circumstances as being sick, tired or highly stressed. As a result, she was a procrastinator. Her avoidance of completing projects stemmed, in part, from her dread of facing this internalized attacker. Because of her intense self-censure, she could not allow herself to acknowledge or to process anger. Her anger was thus internalized, compounding the severity of her self-attacks. When I moved offices, I found the new lock to be tricky, and sometimes had difficulty in getting into my office. One day she came for our scheduled appointment, and I had succeeded in locking us out of my office. As a result, I had to cancel our session. I noted the understandable irritation in her demeanor, and after apologizing for any inconvenience this may have caused her, I rescheduled our next appointment. I told her that I would be open to hearing any feelings or reactions she might have about the incident at our next session. I did not however, either by my tone or by the content of what I said, indicate any self-attacks. I did not say, for example, “I really messed up,” or “I can’t believe I did such a stupid thing.” I also avoided excessive reiteration of the apology. I wanted to model how to acknowledge a mistake and the impact it has on another person without using it as an excuse for self-condemnation. I also wanted to allow her to have her angry feelings. Most of us have had the experience of feeling manipulated out of our emotions by overly profuse apologies. It is as if the person is saying, “please don’t get mad at me, it would be too upsetting.”

At our next session, I briefly touched on what happened, listening for any reaction she might have. Knowing her history, I experienced some apprehension that I had undermined her growing trust in me and my commitment to working with her. I had to take the lead here by processing my own feelings. While I had made an error, I could certainly demonstrate my genuine concern for how this affected her without having to condemn myself. I was thus able to quell my anxiety, and be open to her experience. As expected, she dismissed any feelings about the incident. She vehemently denied any disappointment or anger towards me, which was in contrast with her countenance that I observed at the time. At this point, I said, “It’s OK if you feel annoyed about my mistake. You wouldn’t be my first client to feel that way.” She searched my face anxiously as if trying to sense whether it really was OK, and then she took the plunge. She related to me how she had been looking forward to seeing me because she had a really bad week, and how dejected she felt when she went home, as if even her therapist didn’t care about her. I commended her for taking the risk to be honest, and again reassured her that I was fine with her telling me her feelings. She looked relieved, and, after a pause, she verbalized that even though she was upset at the time she later felt a curious relief about my having made a blunder. This led to an exploration of her long-held belief that everyone else “had it together,” and that she alone lived in a state of inferiority and defectiveness. We also looked at the shame and emotional isolation that resulted from her feelings of being different than everyone else. I then disclosed that I had felt a little bad about what happened, and I recounted how I handled it by accepting my own vulnerability to human errors.  She communicated that she always thought that I judged her for what she perceived were her deficiencies. Now that she had related her true feelings to me, I was able to empathically convey what a trial it must be to feel so judged all of the time, and how hard it must have been for her to continue to come every week with that kind of anxiety. In the end, my mistake opened up an important area of exploration, which was of great benefit to her.

Healing does not involve becoming an imaginary perfect self; rather, it is the realization of our true, imperfect selves. The revelation that we are, in essence, worthwhile and deserving can be a transformative one, and it needs to be experienced repeatedly in order to unlearn the cruel habit of self-attack. Within a framework of basic self-worth and self-respect, we can learn and grow. Essentially, to relinquish perfectionism is to understand that self-regard is our birthright. Our worth does not need to rest precariously on our latest success, nor must we abandon it the moment we encounter an internal or external challenge. It is this insight that frees us from the prison of perfectionism and enables us to lead a more fulfilling and rich life.