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00:00:01
Welcome to the Mastering Therapy Podcast with me, Dr. Natalie Stott, Clinical Psychologist. This is a show for psychologists, psychotherapists, and counselors who are looking to build on their therapy skills, increase confidence in working with clients, and be inspired by alternative models, tools, and ways of working. Join my guests and me as we learn from one another and aim to take insights and put them into action.
Vocaster Two USB:
00:00:31
This week is all about perfectionism, and I talk with senior CBT therapist Natalie Englander, otherwise known on her social media handles as the Perfectionism Therapist. I'd say this episode is split into two parts. The beginning is our discussion on what we understand to be perfectionism, so thinking about Roz Shafran's description and the varied dimensions of perfectionism. Natalie brings her many years of experience with clients to the table and shares her understandings of perfectionism that you're just simply not going to get from a quick Google or in a textbook and it's these insights that make discussions like this so valuable. This episode is primarily focused on working with perfectionism using CBT, and she walks us through how she goes about cognitive restructuring and behavioural experiments. The formulation model she uses is really interesting. There is so much here. I hope you enjoy it.
natalie_1_09-27-2024_100843:
00:01:24
I've asked Natalie to come on today because she is a senior CBT therapist, has been working with perfectionism for over 10 years has worked as a lead within the NHS, but has now got her own private practice. thanks Natalie for joining me.
natalie-englander_1_09-27-2024_100843:
00:01:40
Thank you for having me
natalie_1_09-27-2024_100843:
00:01:42
I'm going to bet that most people listening to this Have an idea of what perfectionism is or might already be working with clients that are self diagnosed perfectionists or might refer to it as a trait that they recognize in themselves. So I thought we might begin with. What you notice in the therapy room in terms of what traits or what things people say that get you thinking about the different types or how perfectionism is manifest in somebody?
natalie-englander_1_09-27-2024_100843:
00:02:14
Yeah, definitely. I'm always holding in mind that more generally, and I'm sure people listening would be familiar with this, that we think of three different types of perfectionism, or kind of three different flavours. I like to think of it is there's the self orientated one. So that's when you expect yourself to be perfect. And that's probably the majority of the ones that I see. But then there's also other orientated. So that's when you expect others to be perfect. And then there's the socially prescribed. So that's when you think others expect you to be perfect. And I'm always kind of holding that in mind to see you. How perfectionism is showing up for them, and whether it's more of that self orientated, other orientated, or socially prescribed. Because, what you do in treatment is then definitely going to look quite different. So for example, the other orientated one, where you expect others to be perfect, that often brings up lots of relationship issues. So that tends to be the main thing that they come to you talking about. They've got really high expectations for other people and that's causing problems. Like they're often disappointed. with their friends, or they're having lots of arguments with their partner, for example. And so, I'm always kind of listening out and thinking in my mind, which, which type of perfectionism are they struggling with the most? But I guess more generally, as I've done this for a long time, probably what I've noticed and again, this is just For me, anecdotally, no, this isn't in a textbook or anything, but I tend to feel like there's the people pleasing ones and they often come to me struggling with, like, overworking and aren't very good at being assertive, struggle with boundaries, that kind of thing. Or there's the low self esteem ones. So they're really struggling with confidence and they're not really progressing or turning down or missing opportunities. And there's definitely the procrastinating ones. They've usually got really high expectations and just can't get stuff done, I guess, because they're wanting it to be perfect, and then they put it off, procrastinate, etc. And then there's the controlling ones. Usually, they're doing too much, taking on everything, whether it's at home or at work, and they can be the ones that struggle with their relationships a bit more. And then the last type of, I don't know if it's the best name, but I sort of think of them as the punitive ones, so they've got lots of self criticism and quite a lot of shame. As well. So I tend to feel like it's sort of those five different types that I see, and they can all feel quite different. I think you've sometimes got as well, like the obvious perfectionist, like your classic high achiever, high functioning anxiety. And then you maybe got the less obvious ones. So maybe they're not really thriving as much. They kind of get quite paralysed. Maybe more of like the messy perfectionist.
natalie_1_09-27-2024_100843:
00:05:25
It's that fear of getting it wrong or fear of failure that can paralyze people to actually do what they want to be doing. So they might have such high expectations of themselves, but they just are so terrified of getting it wrong or failing that they don't end up doing. And then they live a life that's really far removed from their values or what matters to them. So it is a very different presentation, isn't it, to somebody that's, relentlessly working all hours and, that's getting in the way of them being with their families or having social life because they can't, can't not do something to This unrealistic standard.
natalie-englander_1_09-27-2024_100843:
00:06:05
yep, yeah. And I think those are the ones as well that tend to be really unsure about whether they could call themselves a perfectionist or not. But they almost feel a bit embarrassed to say that they're a perfectionist because they think other people would be like, how are you a perfectionist? house is so messy, you're not super organized, kind of more of that classic picture that we tend, tend to think of. They're usually the ones that are really overwhelmed as well, versus The other sort of more obvious perfectionists tend to be more of the anxious ones, I think.
natalie_1_09-27-2024_100843:
00:06:37
And it's tricky because I guess to some degree perfectionism has served someone very positively. And that's often what I've, try and communicate to people that perfectionism isn't always a bad thing. It, can get you to where you want to get to, but the question is then what is it costing you? And. If somebody is in therapy, it's because they're, aware or not content with an aspect of life and it's helping them dissect whether the perfectionism and the perfectionistic traits are actually getting in the way of life for them. I wondered what you tend to observe do you ever have to highlight to people or convince them of I get that this has got you this amazing job or you're in this position of authority. but Look at the cost of this. how do you go about doing that with somebody?
natalie-englander_1_09-27-2024_100843:
00:07:31
yeah, I think that's definitely something that I've changed a bit with over time. So before when I first learned about perfectionism did training learn about, I guess, clinical perfectionism is as Roz Shafran calls it. And a lot of the stuff I read was how it's, it's all bad and you need to overcome it. And. It's not good. And then you felt like you're almost battling a bit with your clients because you're trying to persuade them like this isn't a good thing. You need to stop. We need to get rid of it. And I just don't think that that worked as well. I don't think people are going to feel as motivated or buy into it as much because as you say, actually, maybe it has served a purpose or it's helped them achieve more. And so when I then shifted to thinking about it in a different way and connecting more with the idea that perfectionism is a personality trait, it's not a disorder, it can be healthy and helpful, or it can be. unhealthy and unhelpful. That then, really helped to shift a sort of how we approach things together in therapy and then how the client feels in terms of their motivation. Because I'm saying, actually, I, I believe that Perfectionism isn't all bad. There are some good parts, but at the moment it seems like yours is in that unhealthy, more of that maladaptive range. And what we want to do is not to get rid of all perfectionism, not to try and make you not be a perfectionist. We just want to shift it a bit so that it goes back into that healthy, more adaptive range. And I think that that is much more. appealing to clients, but also it's more realistic. And that's certainly been my own experiences as a perfectionist. I wouldn't want to stop being a perfectionist completely. And I've never yet met another perfectionist who doesn't want to keep some part of it or doesn't like some of it. And so I think, I think that helps quite a lot.
natalie_1_09-27-2024_100843:
00:09:44
I'm thinking about a client that I recently worked with and what was interesting is that she was. explaining that in work, she was fiercely like pushing herself. So she had these incredibly high standards and she was able to identify that this was because she was wanting the approval of other people. Ironically, it had the opposite effect. And she was also very self aware and was able to link it back to When she was younger and she was pushed academically and that's how her family cultivated a sense of worthiness and self worth by what she did, her achievements. And so she was able to recognize that she has these. Unrelenting high standards, so she's coming into work early, leaving late, doing work on weekends, not particularly enjoying the work, but just driven by this sense of, I need to almost outcompete other people, but in other areas of her life, she wasn't, she didn't demand that a friendships or her marriage. So it was interesting. It was very, located to one particular area of her life. And I was wondering when you see that with people, does change how you think about perfectionism or I guess it would be just focused on that one area as opposed to generalizing to other areas of life. Yeah. I mean, that's definitely quite common that perfectionism might not show up in all and every area of their life. It might just be one or two areas. But I'd then be thinking that it's about trying to broaden their schema for self evaluation. So they're basing their self worth all on their work and their sort of striving and achievements at work. So we'd want to be broadening and broadening out how they're evaluating themselves. So yes, work is a big part of that, but what else might be included in that? in how they evaluate themselves. I often talk about with clients, sometimes attempt to draw something on the whiteboard as well, which is always quite entertaining for clients it does not look like a good piece of artwork. But I might draw out a basket and talk about how we don't want to put all our eggs in one basket. And. if things start not going so well with work, if, we base everything all on work, then we might find ourselves feeling pretty rubbish. So it's quite a kind of fragile place to be. Whereas if we can connect with other things that are important to us, other things that we value and start also focusing on those areas too. That's often more helpful because then if things aren't going so well in one area, We're still feeling like this area is great, or that's part of what builds up my own self evaluation. So in some ways, Yeah, it's either you'll get the ones where it's, the perfectionism is showing up everywhere and I guess there's then less of that issue, but you then feel like you've got more to work on, because it's showing up in all these different areas versus if it is just one area. But I often find that it's then quite nice for treatment. You can be really specific and focused on one particular and also try and draw out what, how do they manage. other areas of their life what is it that they can learn from that? They're obviously approaching things differently. I'm sure they probably still have reasonably high standards in other areas, but maybe they're not relentlessly pursuing them. Maybe it doesn't feel catastrophic if things don't go well, or they don't meet their standards. And how, how do they manage that? and seeing if there's anything that they can apply to where it is showing up, say at work with the client you mentioned. But something this might not be helpful to include or not, I'm not sure. But I found that when there's a really stark difference so someone is like super. Let's say on it and organized, meticulous, et cetera, at work. But then every other area of their life seems completely different. And there isn't still kind of some similarities of high standards. Then I would wonder if they might have undiagnosed ADHD. Because. So many of my clients that I work with either have diagnosed ADHD or probably the majority are undiagnosed ADHD and we kind of discover that together. And it's usually a sign that they are maybe kind of, masking or using perfectionism as a way to, to cope when they're say at work. But then in other areas of their lives, they don't need to have those same coping tools in place. Or they're maybe not needing to mask as much. Yeah. Yeah. interesting. And how, how does that go down with people? I imagine that, feels fairly validating to, to realize that there's a good explanation for why. they've. developed this.
natalie-englander_1_09-27-2024_100843:
00:15:06
In my experience, it's certainly always been validating for people, because otherwise they'll tend to be thinking am I just lazy or why can't I do all the things that I want to be able to do, but yeah, I guess there's a certain way that I might go about starting to explore that and discuss that with someone. I wouldn't just say by the way, I think you've got ADHD. Usually it's maybe in the assessment, I would always ask whether they've got any neurodevelopmental disorders. I tend to not just leave it there. If they say no, I'll ask, does anyone else in your family? I'll also ask, have you ever wondered? So I usually have some sense of kind of their views. On what they think about ADHD. So I can be a bit more prepared when we maybe start to explore if it's relevant.
natalie_1_09-27-2024_100843:
00:15:57
So Once you've got an idea of, the type of perfectionism you've mapped out with them, the ways in which it's working for them and not working. Do you then go back and go through maybe where it started? And I was thinking about the various different tools out there that help. With doing that. So, looking at maybe the Shafran CBT model I know you can get it on psychology tools. Do you sit down with a client and go through that with them?
natalie-englander_1_09-27-2024_100843:
00:16:27
Yeah, it's a good question. Because on that model, and it doesn't include anything around core beliefs, or like early maladaptive schemas and things that's generally not discussed in the CBT model of CBT model of perfectionism that I'm sure everyone would have seen or been on the trainings before with Roz Shafran but I think that that for me is the biggest bit that's missing. Because we know from research that perfectionism can have ties to someone's early experiences, whether it's high parental expectations or criticism and, yeah, for me, it often feels That, is a really missing piece. So actually what I tend to do more often than not is we'll formulate together using a longitudinal formulation where we're exploring and talking about the early experiences, trying to capture any core beliefs mostly about themselves, but of course, again, also about others, or the world in general, and then definitely trying to capture any rules and then I guess feeding down into more of that here and now CBT model, capturing the day to day impact the ways that perfectionism is making them think or how it's impacting on their behavior. So generally I use that and that is our formulation that we're always looking at referring back to adding into. And then in terms of the perfectionism model I would use that more in terms of psychoeducation around perfectionism and how we understand it from a CBT perspective and talking about basing our self worth on our achievements. What happens when we meet our standards? It's great, but it's only temporary. And what happens when we don't meet them makes us feel rubbish, blah, blah, blah. So we'll maybe I'll share it on the screen because I do all my therapy work online and look at it and talk through it together. And maybe think about whether it, that resonates with them. And think more generally how it shows up for them in that way. And we might add on specific bits for them, but generally, I just find talking it through and they might say, Oh, yeah, I remember when I was at school, I often would meet my standards, but then I just raised the bar higher and then they might reflect on how now at the moment at work, they feel like they're not meeting the standards. So they're going down the other route. So I'm yeah,, using the model more as a way of understanding perfectionism and psycho ed, but their formulation is longitudinal one. Capturing their core beliefs and their rules, definitely.,
natalie_1_09-27-2024_100843:
00:19:08
if we're focusing solely on perfectionism and when somebody's got the understanding. Where do you tend to start? If you've elicited some core beliefs, you've got your rules for living, I'm really curious how say cognitive restructuring happens with somebody, would you go through cognitive biases with them and do you get them to identify like, Oh wow, I've got this real catastrophic thinking here, or this is very black and white, or do you. point that out to them.
natalie-englander_1_09-27-2024_100843:
00:19:39
Well, I think generally I'll start off more with the here and now stuff. So we'll be working on any, I guess, problematic behavior, problematic thinking. So when we are looking at the ways that they're thinking generally I would probably get up. There are various different ones out there, but pick one of the unhelpful thinking styles sheets or cognitive bias sheets, share it on the screen. I guess they already would have been quite familiar with the idea of negative automatic thoughts and they'll already again start to have built some awareness that they can be very all or nothing. So that black and white thinking, or that they tend to mind read and assume what they know others are thinking about them. So if they struggle with that socially prescribed perfectionism quite a lot. So we probably would have already touched on some of this stuff. But it's always really helpful sharing on the screen so we can both see it together. And then I generally just tend to talk through each one of them, with them, asking, does, does that one feel relevant? Does that resonate with you? If it does, can they think of any examples, how it shows up? And I always love doing it with them because rather than say, have a read of it at home practice or something, because I'll learn. Lots, they'll probably learn more because they're reflecting out loud with me and I'm saying, oh yeah, maybe that one sounds a bit like what you said last time happened in the week or something. And I was quite like as well, getting a sense from them, what do they think is their top three that they tend to do. The most often and then usually I'd have sort of the first home practice when I'm starting cognitive restructuring would be to keep a thought record, which again they would have already done. So a simple thought record with situation, emotions, thoughts, but this time adding on a column where they can label which unhelpful thinking style or cognitive distortion came up for them. So they get. better at spotting it when it's happening. But it's also really interesting for us to then look at next time and see the top three that they thought was most relevant. Is that actually what shows up for them the most? Or was it not what they were expecting? And it's actually, there's another cognitive distortion that's coming up a lot more than what they realized. And then usually building on that, then we look at more of. I guess the thought challenging evidence for, evidence against and then repeat that again found practice with another thought record that goes into that.
natalie_1_09-27-2024_100843:
00:22:18
On the thought challenging, something I've come up against, and I'd be really curious as to what you find I guess some people are very wedded to their standards and how they're perceived by others. And that can be so hard to shift, especially if it's a real sticky core belief. Do you get it often when their evidence for their Thought is actually overwhelming the evidence against, and in that situation, how do you create that flexibility in somebody?
natalie-englander_1_09-27-2024_100843:
00:22:48
Yeah, yeah, that's the kind of thing that probably back in the day when I was less experienced would have terrified me and I would have been like, oh, no, this is all going wrong in the session. But now I love it because I'm like, right, let's, let's challenge this. And of course, it helps when you've built a really nice. therapeutic relationship with someone, it makes it much easier. I'm always really mindful if part of what they're bringing is a core belief that's coming up as the evidence. And I guess I would point that out to them and say, okay, it seems like the evidence for if you're saying that you're, I'm stupid, or I'm not good enough, I'd refer back to their formulation, we might look at that again. And Reflect on how that's more of a core belief that can be a bit more fixed. And we're not necessarily working on that at the moment. So to see what it's like to maybe put that in brackets, let's say for their evidence for so to them, it feels like it is, and it's relevant, but I'm kind of questioning with them. Well, is it, is it a fact or is it an opinion? Technically, we're after something here that would stand up in court an actual piece of evidence. So maybe we need to put a question mark around that one for the time being. Specifically if it's on a core belief. And then the rest of whatever they've put on there. If they've got more in their evidence for than the evidence against I'm going through each point with them and questioning it and, and challenging it. But the way that I work is that I'm doing it not in a way that's really confrontational. I'm, being. Being gentle about it. And also sometimes being humorous as well. I can't think of an example off the top of my head, but saying, Oh, that's interesting that that's something that's in your evidence for, because what about this thing that you told me about? And it's just really helping them to start to create a bit more flexibility in their thinking.
natalie_1_09-27-2024_100843:
00:24:52
It's, it's really making me think of I use ACT quite a lot and thinking about, creating distance from our thoughts, defusion, and then the need for acceptance of that. Because with perfectionism and there really is such a driver of the need for control and that can be quite uncomfortable for people to let go of, which I think is why people can find trying to challenge it hard because even though they've got the logical evidence, it's then that physical part of them that is then managing the Oh, but I have to, then that's uncertainty. And then, then what? So I wondered, is that where you might use mindfulness practice or how do you create that flexibility in them? If you find that they've got the evidence, but it's not quite, I often talk to clients about the head and the heart divide, that our head tells us one thing and then the heart's like, no. How do you use mindfulness in that context?
natalie-englander_1_09-27-2024_100843:
00:25:53
It's, it's at that point, it's probably more maybe less mindfulness and more about once we've challenged or looked at the evidence for and against, maybe been able to come up with an alternative thought. It's reassuring them that it's okay if they don't totally believe this. And there might be, I don't know, 30 percent of them believes the alternative thought that we've come up with. But the rest doesn't. And, and that's okay, because there is that head heart lag, etc, that you described. And that we're not aiming for perfection here, we're just starting to create bit more flexibility, a bit less rigidity in their thinking. So we're not expecting them to believe it all 100 percent and to feel fabulous straight away. It's something that I guess is a process and that they'll build on. And they'll start to feel different as well over time. Whereas the mindfulness stuff, I'm always really conscious of wanting to make sure That I'm not,, not confusing them, but sort of bringing in too many different ways of, of looking at something at the same time. So I maybe save that more mindfulness stuff in terms of how they approach their thoughts to a bit later on. Once I know they've kind of really got it. Got it with thought challenging, generating alternative thoughts, feeling a bit better in that moment. Then maybe later on using it to think about if similar thoughts come up, maybe they've sort of, they've, they've done the challenging piece and there have been some shifts there, but there's these kind of same old ones that tend to stick around, then maybe Using cognitive diffusion at that point where they're able to step back and say, Oh, here's the, I'm going to fail this piece of work thought again. Hi, thanks for coming. Have a nice day kind of thing. So they could start to feel a bit different towards those thoughts as well. And starting to learn maybe some you really want to tackle and challenge. And then maybe others or the bits that are left over perhaps using more of a mindfulness approach can be helpful and, and getting them to think about, they get to, to choose how they respond rather than reacting to that thought as well.
natalie_1_09-27-2024_100843:
00:28:16
And I, I'd be interested to hear how then behavioural experiments fit in. Whether you've got any I know examples of behavioural experiments you've done with people where it's maybe gone really well and the, the client's reflection.
natalie-englander_1_09-27-2024_100843:
00:28:30
Yeah I definitely love behavioural experiments. I find clients are usually pretty on, on board with them as well. Sometimes I will get out a specific behavioural experiment sheets and we will get all the details in there, the prediction, what they're going to do, what they're going to try not to do, et cetera. But generally once we've maybe done that once, it becomes a bit more. Okay, what could be helpful to do over the next week? Essentially, they're doing lots of behavioural experiments generally tends to be lots of, lots of doing less, so less checking or not seeking reassurance or finishing work on time, regardless of whether they've finished their work and just leaving and. Or saying no to something. And I find that it always creates really big shifts where people haven't, haven't considered or felt too afraid to, to do something different or to do less. It's almost like they're being given permission to do that. And I guess. nine times out of ten, they see that it hasn't been a big disaster or a big catastrophe. Everything generally still goes okay. And I think that's then a big turning point where they're like, ah, okay, maybe I don't need to be doing all this stuff. Or maybe what I predict is going to happen doesn't happen. Or if it does, it's not the end of the world. And actually I cope quite well with that.
natalie_1_09-27-2024_100843:
00:30:00
And when I think about how sometimes perfectionism is really about, the avoidance of something, like trying to avoid that feeling of being out of control when they then do less. It's obviously it forces those feelings to come to the surface and maybe people realize in themselves that they are better equipped than they thought to be able to manage that. So sometimes I find is about Oh, this didn't happen in the way that I thought. It's. Also the relationship of, how they see themselves that they realize, Oh, okay. when I avoid it, it's actually costing me all of this. And when I let the feelings come up, yes, that's hard, but it's not as hard as what it costs me. when I'm doing it.
natalie-englander_1_09-27-2024_100843:
00:30:48
the stuff that I'll do with someone working on their rules that they have, or all of those super high standards, but generally I'll call them rules. We spend time looking at and exploring how the rule impacts on them, the origin of it, why or how it developed perhaps it did serve a purpose in the past. We make sense of that, but then definitely looking at the advantages and the disadvantages to help them see that, okay, it might have some advantages. They might feel as though it helps them feel less anxious, but actually the disadvantages of it. Exhausted, burnt out, 10 million other things. And so then when we're able to generate and come up with a new alternative rule or maybe we might call it guideline instead. That's when I tend to do lots of behavioural experiments. Because I never just want to leave it as great. We've created a new guideline or rule for you. Fantastic. Go and live your life with this new rule. We often need to spend a lot of time thinking about, okay, what would that look like in terms of their behaviour What would they actually be doing if they're living by this new rule? So maybe they would be declining invites to things that they don't want to go to. Maybe they'd be, delegating more, maybe they'd be spending less time on tidying their house and keeping it all immaculate. And, they're usually really good at generating lots of ideas for that. And then it's a case of, okay, well, now we need to start doing some of those things. And some will feel easier to do, and they'll start doing them naturally. And then some will feel a bit harder and will. Try and set up a specific behavioural experiment around it for when they do it for the first time to, to see how it goes.
natalie_1_09-27-2024_100843:
00:32:36
Before we finish Natalie, you've referenced a few things that we'll put in the show notes, the various different worksheets, or even that CBT model we spoke about at the beginning. Are there any books that you would recommend I guess people like us could read if they're interested in really drilling down into perfectionism. I know there are lots of TED talks, so many people might have heard of Brené Brown's The Gifts of Imperfection, I think is a great one and clients tend to digest that quite well. Any more of your go to's for clients? and or therapists.
natalie-englander_1_09-27-2024_100843:
00:33:11
So, for therapists I would say this one, the cognitive behavioural treatment of perfectionism um, it's, it's quite a deep dive into perfectionism. Because perfectionism actually causes quite a lot of controversy, amongst the world of psychologists. Is it a disorder? Is it a personality trait? Is it a good thing? Is it a bad thing? How should we treat it? How should we measure it? But it's particularly interesting and helpful. And it's also got loads of different questionnaires, which I found really interesting learning about because most people or CBT therapists would have come across the clinical perfectionism questionnaire, which is Roz Shafran's one. And that one's great, although it doesn't capture the other types of perfectionism like the socially prescribed or the other orientated. So if you've got someone who's coming to you saying I've got such high standards for other people and it's affecting my relationships, that questionnaire isn't going to be as helpful. And then the one I use that is in this book that I really like is the Almost Perfect Scale. The reason why I like it is because it gives you a score that basically says whether or not you're a perfectionist or you're experiencing perfectionism. And then it will show if you're either in the maladaptive or the adaptive range. And I really like that again, because it fits with that idea of, Okay, you're currently in the maladaptive range. Let's work on things and we'll repeat it and see how we shifted into more of that healthy, helpful range. And for clients there's this book, which is when perfect isn't good enough. It's more of a self help book for clients. I mean, obviously it'd be helpful for therapists as well. But I think that one's a really nice one because most people probably think of the overcoming perfectionism self help book, which is definitely good, but I'd recommend.
natalie_1_09-27-2024_100843:
00:35:03
that's the one.
natalie-englander_1_09-27-2024_100843:
00:35:04
one for clients.
natalie_1_09-27-2024_100843:
00:35:05
Uh, the only one that you haven't mentioned that I think is really useful is the Perfectionist Guide to Losing Control.
natalie-englander_1_09-27-2024_100843:
00:35:11
Oh, Yeah,
natalie_1_09-27-2024_100843:
00:35:13
Yeah, so that. is by, Katherine Schaeffler. So we can put that link in, but that's another good one for both client and therapist.
natalie-englander_1_09-27-2024_100843:
00:35:22
There is also on psychology tools, you can get the perfectionism model on there, but along with it. There's an information sort of booklet and it's really good because it's aimed at therapists and it talks you through all the different parts of the model, goes into lots of detail. I think sometimes we look at a model and we're like, Oh yeah, I kind of get it. But this will go through the different parts in a lot more detail. And it also gives questions. suggestions of things that you might be able to ask clients to elicit that part from the model. So I definitely recommend that one.
natalie_1_09-27-2024_100843:
00:36:00
Well, we've reached the end of a time, but Natalie, this has been a really, thorough and packed full of not just what you do, but why you do it and things that we can look out for. So appreciate you sharing your wisdom and insights. Yeah, thank you so much.
natalie-englander_1_09-27-2024_100843:
00:36:18
you so much for having me.
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00:36:21
Thank you for listening to this episode of Mastering Therapy. All of the resources mentioned are available in the show notes. If you're interested in getting more information on what's been covered this season, you can sign up to our mailing list or visit the website masteringtherapy. com. If you've listened to this and you've thought of someone you think would be great to interview on the podcast, submit a recommendation on the website. I'd love to hear from you. Mastering Therapy Podcasts and the information provided by me and my guests is solely intended for qualified professionals for information and educational purposes. I look forward to you joining me next time.
00:00:01
Welcome to the Mastering Therapy Podcast with me, Dr. Natalie Stott, Clinical Psychologist. This is a show for psychologists, psychotherapists, and counselors who are looking to build on their therapy skills, increase confidence in working with clients, and be inspired by alternative models, tools, and ways of working. Join my guests and me as we learn from one another and aim to take insights and put them into action.
Vocaster Two USB:
00:00:31
This week is all about perfectionism, and I talk with senior CBT therapist Natalie Englander, otherwise known on her social media handles as the Perfectionism Therapist. I'd say this episode is split into two parts. The beginning is our discussion on what we understand to be perfectionism, so thinking about Roz Shafran's description and the varied dimensions of perfectionism. Natalie brings her many years of experience with clients to the table and shares her understandings of perfectionism that you're just simply not going to get from a quick Google or in a textbook and it's these insights that make discussions like this so valuable. This episode is primarily focused on working with perfectionism using CBT, and she walks us through how she goes about cognitive restructuring and behavioural experiments. The formulation model she uses is really interesting. There is so much here. I hope you enjoy it.
natalie_1_09-27-2024_100843:
00:01:24
I've asked Natalie to come on today because she is a senior CBT therapist, has been working with perfectionism for over 10 years has worked as a lead within the NHS, but has now got her own private practice. thanks Natalie for joining me.
natalie-englander_1_09-27-2024_100843:
00:01:40
Thank you for having me
natalie_1_09-27-2024_100843:
00:01:42
I'm going to bet that most people listening to this Have an idea of what perfectionism is or might already be working with clients that are self diagnosed perfectionists or might refer to it as a trait that they recognize in themselves. So I thought we might begin with. What you notice in the therapy room in terms of what traits or what things people say that get you thinking about the different types or how perfectionism is manifest in somebody?
natalie-englander_1_09-27-2024_100843:
00:02:14
Yeah, definitely. I'm always holding in mind that more generally, and I'm sure people listening would be familiar with this, that we think of three different types of perfectionism, or kind of three different flavours. I like to think of it is there's the self orientated one. So that's when you expect yourself to be perfect. And that's probably the majority of the ones that I see. But then there's also other orientated. So that's when you expect others to be perfect. And then there's the socially prescribed. So that's when you think others expect you to be perfect. And I'm always kind of holding that in mind to see you. How perfectionism is showing up for them, and whether it's more of that self orientated, other orientated, or socially prescribed. Because, what you do in treatment is then definitely going to look quite different. So for example, the other orientated one, where you expect others to be perfect, that often brings up lots of relationship issues. So that tends to be the main thing that they come to you talking about. They've got really high expectations for other people and that's causing problems. Like they're often disappointed. with their friends, or they're having lots of arguments with their partner, for example. And so, I'm always kind of listening out and thinking in my mind, which, which type of perfectionism are they struggling with the most? But I guess more generally, as I've done this for a long time, probably what I've noticed and again, this is just For me, anecdotally, no, this isn't in a textbook or anything, but I tend to feel like there's the people pleasing ones and they often come to me struggling with, like, overworking and aren't very good at being assertive, struggle with boundaries, that kind of thing. Or there's the low self esteem ones. So they're really struggling with confidence and they're not really progressing or turning down or missing opportunities. And there's definitely the procrastinating ones. They've usually got really high expectations and just can't get stuff done, I guess, because they're wanting it to be perfect, and then they put it off, procrastinate, etc. And then there's the controlling ones. Usually, they're doing too much, taking on everything, whether it's at home or at work, and they can be the ones that struggle with their relationships a bit more. And then the last type of, I don't know if it's the best name, but I sort of think of them as the punitive ones, so they've got lots of self criticism and quite a lot of shame. As well. So I tend to feel like it's sort of those five different types that I see, and they can all feel quite different. I think you've sometimes got as well, like the obvious perfectionist, like your classic high achiever, high functioning anxiety. And then you maybe got the less obvious ones. So maybe they're not really thriving as much. They kind of get quite paralysed. Maybe more of like the messy perfectionist.
natalie_1_09-27-2024_100843:
00:05:25
It's that fear of getting it wrong or fear of failure that can paralyze people to actually do what they want to be doing. So they might have such high expectations of themselves, but they just are so terrified of getting it wrong or failing that they don't end up doing. And then they live a life that's really far removed from their values or what matters to them. So it is a very different presentation, isn't it, to somebody that's, relentlessly working all hours and, that's getting in the way of them being with their families or having social life because they can't, can't not do something to This unrealistic standard.
natalie-englander_1_09-27-2024_100843:
00:06:05
yep, yeah. And I think those are the ones as well that tend to be really unsure about whether they could call themselves a perfectionist or not. But they almost feel a bit embarrassed to say that they're a perfectionist because they think other people would be like, how are you a perfectionist? house is so messy, you're not super organized, kind of more of that classic picture that we tend, tend to think of. They're usually the ones that are really overwhelmed as well, versus The other sort of more obvious perfectionists tend to be more of the anxious ones, I think.
natalie_1_09-27-2024_100843:
00:06:37
And it's tricky because I guess to some degree perfectionism has served someone very positively. And that's often what I've, try and communicate to people that perfectionism isn't always a bad thing. It, can get you to where you want to get to, but the question is then what is it costing you? And. If somebody is in therapy, it's because they're, aware or not content with an aspect of life and it's helping them dissect whether the perfectionism and the perfectionistic traits are actually getting in the way of life for them. I wondered what you tend to observe do you ever have to highlight to people or convince them of I get that this has got you this amazing job or you're in this position of authority. but Look at the cost of this. how do you go about doing that with somebody?
natalie-englander_1_09-27-2024_100843:
00:07:31
yeah, I think that's definitely something that I've changed a bit with over time. So before when I first learned about perfectionism did training learn about, I guess, clinical perfectionism is as Roz Shafran calls it. And a lot of the stuff I read was how it's, it's all bad and you need to overcome it. And. It's not good. And then you felt like you're almost battling a bit with your clients because you're trying to persuade them like this isn't a good thing. You need to stop. We need to get rid of it. And I just don't think that that worked as well. I don't think people are going to feel as motivated or buy into it as much because as you say, actually, maybe it has served a purpose or it's helped them achieve more. And so when I then shifted to thinking about it in a different way and connecting more with the idea that perfectionism is a personality trait, it's not a disorder, it can be healthy and helpful, or it can be. unhealthy and unhelpful. That then, really helped to shift a sort of how we approach things together in therapy and then how the client feels in terms of their motivation. Because I'm saying, actually, I, I believe that Perfectionism isn't all bad. There are some good parts, but at the moment it seems like yours is in that unhealthy, more of that maladaptive range. And what we want to do is not to get rid of all perfectionism, not to try and make you not be a perfectionist. We just want to shift it a bit so that it goes back into that healthy, more adaptive range. And I think that that is much more. appealing to clients, but also it's more realistic. And that's certainly been my own experiences as a perfectionist. I wouldn't want to stop being a perfectionist completely. And I've never yet met another perfectionist who doesn't want to keep some part of it or doesn't like some of it. And so I think, I think that helps quite a lot.
natalie_1_09-27-2024_100843:
00:09:44
I'm thinking about a client that I recently worked with and what was interesting is that she was. explaining that in work, she was fiercely like pushing herself. So she had these incredibly high standards and she was able to identify that this was because she was wanting the approval of other people. Ironically, it had the opposite effect. And she was also very self aware and was able to link it back to When she was younger and she was pushed academically and that's how her family cultivated a sense of worthiness and self worth by what she did, her achievements. And so she was able to recognize that she has these. Unrelenting high standards, so she's coming into work early, leaving late, doing work on weekends, not particularly enjoying the work, but just driven by this sense of, I need to almost outcompete other people, but in other areas of her life, she wasn't, she didn't demand that a friendships or her marriage. So it was interesting. It was very, located to one particular area of her life. And I was wondering when you see that with people, does change how you think about perfectionism or I guess it would be just focused on that one area as opposed to generalizing to other areas of life. Yeah. I mean, that's definitely quite common that perfectionism might not show up in all and every area of their life. It might just be one or two areas. But I'd then be thinking that it's about trying to broaden their schema for self evaluation. So they're basing their self worth all on their work and their sort of striving and achievements at work. So we'd want to be broadening and broadening out how they're evaluating themselves. So yes, work is a big part of that, but what else might be included in that? in how they evaluate themselves. I often talk about with clients, sometimes attempt to draw something on the whiteboard as well, which is always quite entertaining for clients it does not look like a good piece of artwork. But I might draw out a basket and talk about how we don't want to put all our eggs in one basket. And. if things start not going so well with work, if, we base everything all on work, then we might find ourselves feeling pretty rubbish. So it's quite a kind of fragile place to be. Whereas if we can connect with other things that are important to us, other things that we value and start also focusing on those areas too. That's often more helpful because then if things aren't going so well in one area, We're still feeling like this area is great, or that's part of what builds up my own self evaluation. So in some ways, Yeah, it's either you'll get the ones where it's, the perfectionism is showing up everywhere and I guess there's then less of that issue, but you then feel like you've got more to work on, because it's showing up in all these different areas versus if it is just one area. But I often find that it's then quite nice for treatment. You can be really specific and focused on one particular and also try and draw out what, how do they manage. other areas of their life what is it that they can learn from that? They're obviously approaching things differently. I'm sure they probably still have reasonably high standards in other areas, but maybe they're not relentlessly pursuing them. Maybe it doesn't feel catastrophic if things don't go well, or they don't meet their standards. And how, how do they manage that? and seeing if there's anything that they can apply to where it is showing up, say at work with the client you mentioned. But something this might not be helpful to include or not, I'm not sure. But I found that when there's a really stark difference so someone is like super. Let's say on it and organized, meticulous, et cetera, at work. But then every other area of their life seems completely different. And there isn't still kind of some similarities of high standards. Then I would wonder if they might have undiagnosed ADHD. Because. So many of my clients that I work with either have diagnosed ADHD or probably the majority are undiagnosed ADHD and we kind of discover that together. And it's usually a sign that they are maybe kind of, masking or using perfectionism as a way to, to cope when they're say at work. But then in other areas of their lives, they don't need to have those same coping tools in place. Or they're maybe not needing to mask as much. Yeah. Yeah. interesting. And how, how does that go down with people? I imagine that, feels fairly validating to, to realize that there's a good explanation for why. they've. developed this.
natalie-englander_1_09-27-2024_100843:
00:15:06
In my experience, it's certainly always been validating for people, because otherwise they'll tend to be thinking am I just lazy or why can't I do all the things that I want to be able to do, but yeah, I guess there's a certain way that I might go about starting to explore that and discuss that with someone. I wouldn't just say by the way, I think you've got ADHD. Usually it's maybe in the assessment, I would always ask whether they've got any neurodevelopmental disorders. I tend to not just leave it there. If they say no, I'll ask, does anyone else in your family? I'll also ask, have you ever wondered? So I usually have some sense of kind of their views. On what they think about ADHD. So I can be a bit more prepared when we maybe start to explore if it's relevant.
natalie_1_09-27-2024_100843:
00:15:57
So Once you've got an idea of, the type of perfectionism you've mapped out with them, the ways in which it's working for them and not working. Do you then go back and go through maybe where it started? And I was thinking about the various different tools out there that help. With doing that. So, looking at maybe the Shafran CBT model I know you can get it on psychology tools. Do you sit down with a client and go through that with them?
natalie-englander_1_09-27-2024_100843:
00:16:27
Yeah, it's a good question. Because on that model, and it doesn't include anything around core beliefs, or like early maladaptive schemas and things that's generally not discussed in the CBT model of CBT model of perfectionism that I'm sure everyone would have seen or been on the trainings before with Roz Shafran but I think that that for me is the biggest bit that's missing. Because we know from research that perfectionism can have ties to someone's early experiences, whether it's high parental expectations or criticism and, yeah, for me, it often feels That, is a really missing piece. So actually what I tend to do more often than not is we'll formulate together using a longitudinal formulation where we're exploring and talking about the early experiences, trying to capture any core beliefs mostly about themselves, but of course, again, also about others, or the world in general, and then definitely trying to capture any rules and then I guess feeding down into more of that here and now CBT model, capturing the day to day impact the ways that perfectionism is making them think or how it's impacting on their behavior. So generally I use that and that is our formulation that we're always looking at referring back to adding into. And then in terms of the perfectionism model I would use that more in terms of psychoeducation around perfectionism and how we understand it from a CBT perspective and talking about basing our self worth on our achievements. What happens when we meet our standards? It's great, but it's only temporary. And what happens when we don't meet them makes us feel rubbish, blah, blah, blah. So we'll maybe I'll share it on the screen because I do all my therapy work online and look at it and talk through it together. And maybe think about whether it, that resonates with them. And think more generally how it shows up for them in that way. And we might add on specific bits for them, but generally, I just find talking it through and they might say, Oh, yeah, I remember when I was at school, I often would meet my standards, but then I just raised the bar higher and then they might reflect on how now at the moment at work, they feel like they're not meeting the standards. So they're going down the other route. So I'm yeah,, using the model more as a way of understanding perfectionism and psycho ed, but their formulation is longitudinal one. Capturing their core beliefs and their rules, definitely.,
natalie_1_09-27-2024_100843:
00:19:08
if we're focusing solely on perfectionism and when somebody's got the understanding. Where do you tend to start? If you've elicited some core beliefs, you've got your rules for living, I'm really curious how say cognitive restructuring happens with somebody, would you go through cognitive biases with them and do you get them to identify like, Oh wow, I've got this real catastrophic thinking here, or this is very black and white, or do you. point that out to them.
natalie-englander_1_09-27-2024_100843:
00:19:39
Well, I think generally I'll start off more with the here and now stuff. So we'll be working on any, I guess, problematic behavior, problematic thinking. So when we are looking at the ways that they're thinking generally I would probably get up. There are various different ones out there, but pick one of the unhelpful thinking styles sheets or cognitive bias sheets, share it on the screen. I guess they already would have been quite familiar with the idea of negative automatic thoughts and they'll already again start to have built some awareness that they can be very all or nothing. So that black and white thinking, or that they tend to mind read and assume what they know others are thinking about them. So if they struggle with that socially prescribed perfectionism quite a lot. So we probably would have already touched on some of this stuff. But it's always really helpful sharing on the screen so we can both see it together. And then I generally just tend to talk through each one of them, with them, asking, does, does that one feel relevant? Does that resonate with you? If it does, can they think of any examples, how it shows up? And I always love doing it with them because rather than say, have a read of it at home practice or something, because I'll learn. Lots, they'll probably learn more because they're reflecting out loud with me and I'm saying, oh yeah, maybe that one sounds a bit like what you said last time happened in the week or something. And I was quite like as well, getting a sense from them, what do they think is their top three that they tend to do. The most often and then usually I'd have sort of the first home practice when I'm starting cognitive restructuring would be to keep a thought record, which again they would have already done. So a simple thought record with situation, emotions, thoughts, but this time adding on a column where they can label which unhelpful thinking style or cognitive distortion came up for them. So they get. better at spotting it when it's happening. But it's also really interesting for us to then look at next time and see the top three that they thought was most relevant. Is that actually what shows up for them the most? Or was it not what they were expecting? And it's actually, there's another cognitive distortion that's coming up a lot more than what they realized. And then usually building on that, then we look at more of. I guess the thought challenging evidence for, evidence against and then repeat that again found practice with another thought record that goes into that.
natalie_1_09-27-2024_100843:
00:22:18
On the thought challenging, something I've come up against, and I'd be really curious as to what you find I guess some people are very wedded to their standards and how they're perceived by others. And that can be so hard to shift, especially if it's a real sticky core belief. Do you get it often when their evidence for their Thought is actually overwhelming the evidence against, and in that situation, how do you create that flexibility in somebody?
natalie-englander_1_09-27-2024_100843:
00:22:48
Yeah, yeah, that's the kind of thing that probably back in the day when I was less experienced would have terrified me and I would have been like, oh, no, this is all going wrong in the session. But now I love it because I'm like, right, let's, let's challenge this. And of course, it helps when you've built a really nice. therapeutic relationship with someone, it makes it much easier. I'm always really mindful if part of what they're bringing is a core belief that's coming up as the evidence. And I guess I would point that out to them and say, okay, it seems like the evidence for if you're saying that you're, I'm stupid, or I'm not good enough, I'd refer back to their formulation, we might look at that again. And Reflect on how that's more of a core belief that can be a bit more fixed. And we're not necessarily working on that at the moment. So to see what it's like to maybe put that in brackets, let's say for their evidence for so to them, it feels like it is, and it's relevant, but I'm kind of questioning with them. Well, is it, is it a fact or is it an opinion? Technically, we're after something here that would stand up in court an actual piece of evidence. So maybe we need to put a question mark around that one for the time being. Specifically if it's on a core belief. And then the rest of whatever they've put on there. If they've got more in their evidence for than the evidence against I'm going through each point with them and questioning it and, and challenging it. But the way that I work is that I'm doing it not in a way that's really confrontational. I'm, being. Being gentle about it. And also sometimes being humorous as well. I can't think of an example off the top of my head, but saying, Oh, that's interesting that that's something that's in your evidence for, because what about this thing that you told me about? And it's just really helping them to start to create a bit more flexibility in their thinking.
natalie_1_09-27-2024_100843:
00:24:52
It's, it's really making me think of I use ACT quite a lot and thinking about, creating distance from our thoughts, defusion, and then the need for acceptance of that. Because with perfectionism and there really is such a driver of the need for control and that can be quite uncomfortable for people to let go of, which I think is why people can find trying to challenge it hard because even though they've got the logical evidence, it's then that physical part of them that is then managing the Oh, but I have to, then that's uncertainty. And then, then what? So I wondered, is that where you might use mindfulness practice or how do you create that flexibility in them? If you find that they've got the evidence, but it's not quite, I often talk to clients about the head and the heart divide, that our head tells us one thing and then the heart's like, no. How do you use mindfulness in that context?
natalie-englander_1_09-27-2024_100843:
00:25:53
It's, it's at that point, it's probably more maybe less mindfulness and more about once we've challenged or looked at the evidence for and against, maybe been able to come up with an alternative thought. It's reassuring them that it's okay if they don't totally believe this. And there might be, I don't know, 30 percent of them believes the alternative thought that we've come up with. But the rest doesn't. And, and that's okay, because there is that head heart lag, etc, that you described. And that we're not aiming for perfection here, we're just starting to create bit more flexibility, a bit less rigidity in their thinking. So we're not expecting them to believe it all 100 percent and to feel fabulous straight away. It's something that I guess is a process and that they'll build on. And they'll start to feel different as well over time. Whereas the mindfulness stuff, I'm always really conscious of wanting to make sure That I'm not,, not confusing them, but sort of bringing in too many different ways of, of looking at something at the same time. So I maybe save that more mindfulness stuff in terms of how they approach their thoughts to a bit later on. Once I know they've kind of really got it. Got it with thought challenging, generating alternative thoughts, feeling a bit better in that moment. Then maybe later on using it to think about if similar thoughts come up, maybe they've sort of, they've, they've done the challenging piece and there have been some shifts there, but there's these kind of same old ones that tend to stick around, then maybe Using cognitive diffusion at that point where they're able to step back and say, Oh, here's the, I'm going to fail this piece of work thought again. Hi, thanks for coming. Have a nice day kind of thing. So they could start to feel a bit different towards those thoughts as well. And starting to learn maybe some you really want to tackle and challenge. And then maybe others or the bits that are left over perhaps using more of a mindfulness approach can be helpful and, and getting them to think about, they get to, to choose how they respond rather than reacting to that thought as well.
natalie_1_09-27-2024_100843:
00:28:16
And I, I'd be interested to hear how then behavioural experiments fit in. Whether you've got any I know examples of behavioural experiments you've done with people where it's maybe gone really well and the, the client's reflection.
natalie-englander_1_09-27-2024_100843:
00:28:30
Yeah I definitely love behavioural experiments. I find clients are usually pretty on, on board with them as well. Sometimes I will get out a specific behavioural experiment sheets and we will get all the details in there, the prediction, what they're going to do, what they're going to try not to do, et cetera. But generally once we've maybe done that once, it becomes a bit more. Okay, what could be helpful to do over the next week? Essentially, they're doing lots of behavioural experiments generally tends to be lots of, lots of doing less, so less checking or not seeking reassurance or finishing work on time, regardless of whether they've finished their work and just leaving and. Or saying no to something. And I find that it always creates really big shifts where people haven't, haven't considered or felt too afraid to, to do something different or to do less. It's almost like they're being given permission to do that. And I guess. nine times out of ten, they see that it hasn't been a big disaster or a big catastrophe. Everything generally still goes okay. And I think that's then a big turning point where they're like, ah, okay, maybe I don't need to be doing all this stuff. Or maybe what I predict is going to happen doesn't happen. Or if it does, it's not the end of the world. And actually I cope quite well with that.
natalie_1_09-27-2024_100843:
00:30:00
And when I think about how sometimes perfectionism is really about, the avoidance of something, like trying to avoid that feeling of being out of control when they then do less. It's obviously it forces those feelings to come to the surface and maybe people realize in themselves that they are better equipped than they thought to be able to manage that. So sometimes I find is about Oh, this didn't happen in the way that I thought. It's. Also the relationship of, how they see themselves that they realize, Oh, okay. when I avoid it, it's actually costing me all of this. And when I let the feelings come up, yes, that's hard, but it's not as hard as what it costs me. when I'm doing it.
natalie-englander_1_09-27-2024_100843:
00:30:48
the stuff that I'll do with someone working on their rules that they have, or all of those super high standards, but generally I'll call them rules. We spend time looking at and exploring how the rule impacts on them, the origin of it, why or how it developed perhaps it did serve a purpose in the past. We make sense of that, but then definitely looking at the advantages and the disadvantages to help them see that, okay, it might have some advantages. They might feel as though it helps them feel less anxious, but actually the disadvantages of it. Exhausted, burnt out, 10 million other things. And so then when we're able to generate and come up with a new alternative rule or maybe we might call it guideline instead. That's when I tend to do lots of behavioural experiments. Because I never just want to leave it as great. We've created a new guideline or rule for you. Fantastic. Go and live your life with this new rule. We often need to spend a lot of time thinking about, okay, what would that look like in terms of their behaviour What would they actually be doing if they're living by this new rule? So maybe they would be declining invites to things that they don't want to go to. Maybe they'd be, delegating more, maybe they'd be spending less time on tidying their house and keeping it all immaculate. And, they're usually really good at generating lots of ideas for that. And then it's a case of, okay, well, now we need to start doing some of those things. And some will feel easier to do, and they'll start doing them naturally. And then some will feel a bit harder and will. Try and set up a specific behavioural experiment around it for when they do it for the first time to, to see how it goes.
natalie_1_09-27-2024_100843:
00:32:36
Before we finish Natalie, you've referenced a few things that we'll put in the show notes, the various different worksheets, or even that CBT model we spoke about at the beginning. Are there any books that you would recommend I guess people like us could read if they're interested in really drilling down into perfectionism. I know there are lots of TED talks, so many people might have heard of Brené Brown's The Gifts of Imperfection, I think is a great one and clients tend to digest that quite well. Any more of your go to's for clients? and or therapists.
natalie-englander_1_09-27-2024_100843:
00:33:11
So, for therapists I would say this one, the cognitive behavioural treatment of perfectionism um, it's, it's quite a deep dive into perfectionism. Because perfectionism actually causes quite a lot of controversy, amongst the world of psychologists. Is it a disorder? Is it a personality trait? Is it a good thing? Is it a bad thing? How should we treat it? How should we measure it? But it's particularly interesting and helpful. And it's also got loads of different questionnaires, which I found really interesting learning about because most people or CBT therapists would have come across the clinical perfectionism questionnaire, which is Roz Shafran's one. And that one's great, although it doesn't capture the other types of perfectionism like the socially prescribed or the other orientated. So if you've got someone who's coming to you saying I've got such high standards for other people and it's affecting my relationships, that questionnaire isn't going to be as helpful. And then the one I use that is in this book that I really like is the Almost Perfect Scale. The reason why I like it is because it gives you a score that basically says whether or not you're a perfectionist or you're experiencing perfectionism. And then it will show if you're either in the maladaptive or the adaptive range. And I really like that again, because it fits with that idea of, Okay, you're currently in the maladaptive range. Let's work on things and we'll repeat it and see how we shifted into more of that healthy, helpful range. And for clients there's this book, which is when perfect isn't good enough. It's more of a self help book for clients. I mean, obviously it'd be helpful for therapists as well. But I think that one's a really nice one because most people probably think of the overcoming perfectionism self help book, which is definitely good, but I'd recommend.
natalie_1_09-27-2024_100843:
00:35:03
that's the one.
natalie-englander_1_09-27-2024_100843:
00:35:04
one for clients.
natalie_1_09-27-2024_100843:
00:35:05
Uh, the only one that you haven't mentioned that I think is really useful is the Perfectionist Guide to Losing Control.
natalie-englander_1_09-27-2024_100843:
00:35:11
Oh, Yeah,
natalie_1_09-27-2024_100843:
00:35:13
Yeah, so that. is by, Katherine Schaeffler. So we can put that link in, but that's another good one for both client and therapist.
natalie-englander_1_09-27-2024_100843:
00:35:22
There is also on psychology tools, you can get the perfectionism model on there, but along with it. There's an information sort of booklet and it's really good because it's aimed at therapists and it talks you through all the different parts of the model, goes into lots of detail. I think sometimes we look at a model and we're like, Oh yeah, I kind of get it. But this will go through the different parts in a lot more detail. And it also gives questions. suggestions of things that you might be able to ask clients to elicit that part from the model. So I definitely recommend that one.
natalie_1_09-27-2024_100843:
00:36:00
Well, we've reached the end of a time, but Natalie, this has been a really, thorough and packed full of not just what you do, but why you do it and things that we can look out for. So appreciate you sharing your wisdom and insights. Yeah, thank you so much.
natalie-englander_1_09-27-2024_100843:
00:36:18
you so much for having me.
undefined:
00:36:21
Thank you for listening to this episode of Mastering Therapy. All of the resources mentioned are available in the show notes. If you're interested in getting more information on what's been covered this season, you can sign up to our mailing list or visit the website masteringtherapy. com. If you've listened to this and you've thought of someone you think would be great to interview on the podcast, submit a recommendation on the website. I'd love to hear from you. Mastering Therapy Podcasts and the information provided by me and my guests is solely intended for qualified professionals for information and educational purposes. I look forward to you joining me next time.
