The efficacy of group psychotherapy for adults with perfectionism: A randomized controlled trial of dynamic-relational therapy versus psychodynamic supportive therapy.

Abstract

Objective: This randomized controlled trial investigated the efficacy of group dynamic-relational therapy (DRT) relative to group psychodynamic supportive therapy (PST) in treating perfectionism and improving psychological functioning. Hypothesis: Psychodynamically informed therapies, particularly DRT, will be efficacious in treating perfectionism and functioning outcomes. Method: Based on a comprehensive conceptualization of perfectionism, 80 community-recruited, highly perfectionistic individuals were randomly allocated to 12 sessions of group DRT (n = 41; 5 groups) or group PST (n = 39; 5 groups). Patients completed measures of trait perfectionism, perfectionistic self-presentation, perfectionistic cognitions, symptom distress, life satisfaction, and work and social adjustment at pre-, mid-, and posttreatment and 6 months posttreatment. Results: Multigroup latent growth curve modeling revealed significant (p < .05) decreases in all perfectionism components and improvements in all functioning outcomes from pretreatment to 6-month follow-up in both DRT and PST. Likewise, analyses revealed substantial reliable improvement across conditions for all perfectionism components. Last, moderate-to-large between-group differences favoring DRT over PST were found for self-oriented perfectionism, perfectionistic self-promotion, nondisplay of imperfection, nondisclosure of imperfection, and work and social adjustment. Conclusion: Findings provide evidence for the use of psychodynamic approaches in the treatment of perfectionism and support the relative efficacy of DRT for components of perfectionism. What is the public health significance of this article?This study found evidence supporting the efficacy of psychodynamically informed treatments for perfectionism, a pernicious vulnerability factor in many disorders and dysfunctions. Results also indicated that dynamic-relational therapy was superior to psychodynamic supportive therapy for most components of perfectionism and work and social adjustment. The findings support the importance of psychodynamic group psychotherapy approaches, and dynamic-relational therapy in particular, in treating perfectionism.

Perfectionism.

“…Moreover, the average reduction in depressive symptoms, and the percentage of patients who showed clinically significant improvements in depressive symptoms, was significantly larger for patients who received DRT than patients who received PST. Analyses showed significant changes in all perfectionism components and depression from pre-treatment to post treatment and follow up (Hewitt, Kealy, et al, 2022) in both groups.…”

“…Finally, we have also introduced an intrapersonal or self-relational component of perfectionism that is reflected, in part, by an individual's internal dialogue with the self. We suggested that this involves not only automatic perfectionistic self-statements and thoughts (Flett et al, 1998) but also automatic critical self-recriminations (Hewitt, Kealy, et al, 2022) and concerns over shortfalls and perceived errors (see Frost et al, 1990). Moreover, we have indicated that this component reflects a behavioral element involving neglect of the self in terms of limited self-care and self-denial.…”

“…The findings of these two studies suggest that not only does a treatment that focuses on the underlying putative cause of depression reduce the vulnerability factor (i.e., perfectionism), it also reduces the depressive symptoms themselves. Extending this work, we recently completed a randomized controlled trial comparing DRT with a supportive psychotherapy (PST) control (the UBC TPS II; Hewitt, Kealy, et al, 2022). Again, we used well-trained senior clinical psychology graduate students under the direct supervision of PLH and SFM for the DRT (Hewitt et al, 2017) or Dr. David Kealy, an expert in psychodynamic supportive treatment (e.g., Kealy et al, 2019;Rasmussen & Kealy, 2020) for the PST, to ensure fidelity and adherence in both treatment approaches.…”

“…Evidence appears to be accumulating for the effectiveness and efficacy of the DRT. Moreover, psychodynamic treatments, including both the DRT and PST groups, that focus on the relational underpinnings and use relational interventions (Hewitt et al, 2015;Hewitt, Kealy, et al, 2022;Hewitt, Qiu, et al, 2020) appear to reduce not only depression symptoms but, importantly, the putative vulnerability that contributes to the experience of depression. The DRT, in particular, appears to offer significant benefit to individuals with perfectionism by effecting changes not only in perfectionism traits, self-presentation, self-relational, and attitudinal elements but also in symptoms of depression.…”

A meta-analytic test of the efficacy of cognitive behavioural therapy for perfectionism: A replication and extension.

“…One possibility is that unlike concerns over mistakes, trait perfectionism dimensions reflect more deeply engrained ways of relating to the self and others that require a greater relational and supportive emphasis to effect meaningful change. In support, Hewitt et al (2023) randomly assigned participants with clinically elevated perfectionism to 12 sessions of dynamic relational therapy for perfectionism (DRT) or 12 sessions of psychodynamic supportive therapy for perfectionism (PST). At posttreatment, 92%, 38%, and 49% of patients in DRT experienced reliable improvements in self-oriented, other-oriented, and socially prescribed perfectionism, and 85%, 61%, and 39% of patients in PST experienced reliable improvements in self-oriented, other-oriented, and socially prescribed perfectionism.…”