Dynamic‐relational treatment of perfectionism: An illustrative case study

Abstract

Objective: Perfectionism has been described as a multidimensional core vulnerability factor in various forms of dysfunction and disorders. Recently, we described our empirically supported-dynamic-relational treatment for perfectionism. This treatment integrates psychodynamic and interpersonal principles to reduce perfectionism and symptoms and enhance relationships with others and self by focusing on underlying relational patterns. Method: We discuss this approach and present Azure, a 27-year-old woman who completed our group treatment and subsequent individual therapy as a follow-up. Results: Azure underwent a comprehensive psychological pretreatment assessment, the results of which were used to develop a working formulation that guided the group and individual psychotherapy. A description of the formulation and her experience in therapy are discussed and pre-and post-treatment data illustrate changes in Azure's perfectionism and symptoms. Conclusions: We discuss changes that occurred over the course of treatment.

Concluding commentary: Treating perfectionism transdiagnostically with an eye on the future

“…They also fulfill the overly controlled coping criterion relying on excessive control in almost all life instances, which limits their opportunities to learn new ways of coping. As in the case of Hewitt et al (2020), the interpersonal element is evident in the case formulation as the societal factor has an important role in the maintenance of perfectionism through the reinforcement of perfectionistic behaviors, which again complements nicely the current selection of papers.…”

“…Third, Hewitt et al (2020) add an interpersonal nuance to the understanding of perfectionism. The premises of their dynamic‐interpersonal approach are that perfectionism arises out of early relational experiences and is maintained by enduring relational contexts where one feels the need, among others, to be or appear perfect.…”

“…The six clinical cases differed in their way of conceptualizing maladaptive perfectionism and this was the starting point for distinct treatment plans. Some viewed maladaptive perfectionisms as (a) a maladaptive overcontrolled coping style (i.e., Cheli et al, 2020; Codd & Little, 2020; Matos & Steindl, 2020), (b) a faulty implicit emotional learning style (Vaz & Ecker, 2020), or (c) even a personality style that arises out of early relational experiences (i.e., Hewitt et al, 2020). Others, conceptualized perfectionism as a rigid and inflexible belief or schema in regard to oneself and in relationship to others (i.e., Cheli et al, 2020; Matos & Steindl, 2020; Rozental, 2020).…”

Procrastination, Perfectionism, and Other Work-Related Mental Problems: Prevalence, Types, Assessment, and Treatment—A Scoping Review

“…Furthermore, insecure attachment styles (avoidant or anxious) are associated with less adaptive coping in response to workplace stress (39). Perfectionism is another relevant construct regarding work-related problems that is related to psychopathology and maladjustment and has been proposed as a transdiagnostic process of psychopathology (47)(48)(49)(50). Especially self-oriented perfectionism may represent a form of counterproductive overstriving (51).…”

“…For the treatment of perfectionism, a psychodynamicinterpersonal therapy has been developed which focuses on the dynamic and relational underpinnings of perfectionism (50). Perfectionism is regarded as both a defense against intolerable affects resulting from unfulfilled needs (e.g., for acceptance, self-worth) and as a means of gaining acceptance or garnering self-worth.…”