Doing Therapy with Perfectionists

​People are often curious about what goes through their therapist’s mind, how they feel about them, what emotions they have.  While I do not work only with PCS (Perfectionism, Control issues, Shame) issues, most of my clients are of this type.  First, I have to say that I believe the way I feel toward my clients is a special kind of love.  These clients -- and I say this after over thirty years of practice -- are kind, good people, extremely considerate, and very ethical.  They wish no harm to anyone, and if they only treated themselves as well as they treat others they would have no problem at all.  Interestingly, people in this group tend to be very, very bright.
 
People often call for an appointment and describe themselves as highly accomplished, which they are; they go on to tell me that they are in a lot of pain, with anxiety and self-depreciation.  They almost always sound like they think they are very unusual, excelling in what they do yet feeling this way, but actually it is common.  People who drive themselves hard do not just do it for a goal or to do a good job, but to keep overriding feelings of being unworthy.  The monster must be fed, and accomplishments follow each other at a rapid rate to keep the real feeling, of being inadequate or bad in some way, out of awareness.  People call to get help, because they are exhausted and do not want to suffer anymore.  They don’t realize that with insight-oriented therapy, such as a psychoanalytically or psychodynamically-oriented therapy, bringing the real, underlying feelings into awareness is what they need to do.  They know they have very sad feelings; that’s why they keep pushing them back with all their achievements.
 
One thing that has been very hard for me is to see such talented people -- intellectually, artistically, businesswise, etc. -- think so little of themselves.  After thirty years I do not feel so enraged for what happened to them, but I still feel anger.  I often think of people who raise, with caring and love, children with cognitive limitations, and when they grow up, they are confident in themselves and kind to others.  That’s an amazing achievement and certainly not an easy one in our competitive society.  Then I think, “But it takes a real talent to have a gifted child, and to convince that child that he or she is totally inadequate and just not good enough.”  To make someone believe what flies in the face of reality is quite an achievement, a terrible one.  While some parents are quite disturbed and just out-and-out mean, others are well intentioned, and because of how they themselves were raised, impart the message that, if something is not perfect, it is nothing.  We have all heard the saying, “Better to not do it at all if it is not done right.”  That may be true if we are talking about something important and work-related, but in everyday life, is it not how we learn?  And is it then surprising how many adults are terrified to try anything new, because they might not excel at it?  The degree to which people are stifled at times seems to me a kind of soul death, and it is truly heartbreaking.

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