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.

​Looking at what people need to heal, it is also heartbreaking to not always give them what they want.  Oh, I want to!  But if I were to collude with people to keep at bay those feelings driving their misery I would be violating my objective of helping people get better and achieve greater authenticity, not stay the same.  I believe that my clients know that I love them and have utmost respect for them, and I know that what I say, or don’t, matters to them a lot.  It carries weight.  When a perfectionist tells me about a new achievement, what do I do?  Do I jump on the bandwagon and become yet one more person who needs to see achievements in order to value the person?  How can I do this if the goal is for them to heal?  I cannot.  I cannot let them get the message that I need to be impressed by these achievements to see their value and to care deeply about them.  I don’t know how many times I have heard, early on in therapy, that nothing impresses me, that I am stingy with praise.  This is not a part I like, and sometimes doing the right thing does not provide immediate gratification.  I might ask if this is important to them, what they would like me to say, or something to that effect.  I believe that they are not their achievements, but unique, valued individuals in their own right.  I cannot act like their worth comes from their achievements.  The gratification comes later.  But it takes time to face the feelings driving such perfectionism and anxiety, as I discuss in my book.  Those pushed-back feelings are not the happy ones.  I only comfort clients when the message is real and true—what the person has been through and still was not corrupted, the courage shown, the considerations that I appreciate.  But they do not have to perform for me and I cannot and will not encourage that behavior.  Why not just comfort and compliment them on their achievements? Because perfectionism didn’t just happen: It was born of emotional pain, sometimes agony, and feeling like a horrible person if they aren’t perfect. 
My clients are all intellectually or artistically superior for some reason.  My fondness for them is not because of that.  But to a person who never knew any other way of being valued and cared for, he or she might not know that right away, and thus I get told that I am stingy with praise, hard to please.  I don’t say this, but I am the easiest person to please they will ever meet.  It is a trap that would be easy to fall into, but I have done this for a long time and I don’t fall into it.  If there were a way to just comfort a person (and at appropriate times I do) and have them heal, I would.  But the clients’ need to  form their narratives, and slowly and with every consideration to their dignity, t. They need to face the sad feelings that make them strive for what is impossible.  This works.  It is a tremendous joy to see people getting better and watching as they notice it in one small way or another, but it’s not easy.  It would be so much easier to say what people want and watch them smile and say how nice you are, but that is not what we’re trying to do.  I will not betray their trust in me that I will try my best to help them heal, that I will provide the safe and understanding environment they need to do that.  This is not done overnight.  It takes time.  We do not like to face what we have struggled to keep out of awareness.  When people get impatient and want all the suffering to end, I silently think how it will be as fast as they themselves can tolerate.  Recently, there was a post of a study saying that one therapy session is as good as many.  WHAT?  I wondered if an insurance company did that study.  It is so not true.
 
I will end by sharing an exchange I had with my wonderful psychoanalyst, back in my 30s.  I told him about something, a score I had on a test or something like that.  He was old school and always called me Mrs. Edwards.  He said, “Mrs. Edwards, why are you trying to impress me?”  Dear God!  What can one say?  He then said, “Why are you trying to impress me with your intelligence?”  What was I going to say, that I wasn’t doing that?  LOL, right?  I think I said, “Oh my God” or something like that.  I took a couple of deep breaths and mumbled something about wanting him to think well of me.  He said that he did, and didn’t care about things like that test.  He was wonderful and seeing him was one of the nicer things I ever did for myself.  I am not so direct.  I know something like that has to be said, but I say it in a much gentler and roundabout way, and for all I know, he may also have with some.  I might be very low key about it, or ask why those things matter, but his excellent intervention was very to the point and I was at a point to cope with the embarrassment of it, because I knew how much he cared.
 
I love being a therapist.  I love working with perfectionists, and they are great people.  However, sometimes, like clients, we have to delay gratification, too, and just deal with it if clients interpret our behavior as being hard to impress, etc.  It is a wonderful job and the reward comes when you see people really healing.  Shortly after that they don’t need you anymore, and that, too, is part of the job -- again not my favorite part, but it is the goal.