Perfectionism represents a broad and multidimensional personality vulnerability for mental disorders and dysfunctions like depression, anxiety, suicide ideation, and relationship distress. The comprehensive model of perfectionistic behaviors assesses three components: (1) perfectionistic traits (stable and consistent personality factors that drive the requirement of perfection [including self-oriented perfectionism; other-oriented perfectionism; socially prescribed perfectionism]), (2) interpersonal expression of perfection (an individual’s drive to appear perfect to others [including perfectionistic self-promotion; non-display of imperfection; nondisclosure of imperfection]), and (3) self-relational component of perfectionism (automatic and self-critical statements [that is, perfectionistic cognitions]). Given that perfectionism has a negative effect on psychological health, previous treatments have been tested to reduce perfectionism with mixed results. For example, CBT may reduce perfectionistic cognitions, but does not always reduce perfectionistic traits. More recently, Hewitt and colleagues developed a dynamic-relational therapy (DRT) in a group format to address all dimensions of perfectionism. In this treatment, therapists promote the expression of emotions and interpersonal feedback among group members. The emphasis is to address relational patterns as they occur in the group. In this randomized controlled trial, Hewitt and colleagues tested the efficacy of DRT relative to group psychodynamic supportive therapy (PST) in treating perfectionism and psychological functioning. They assessed all components of the comprehensive model of perfectionism, mental health symptoms, and social and work adjustment. They hypothesized that both DRT and PST would reduce perfectionism and improve functioning. However, they also predicted that DRT would be more effective than PST because DRT therapists link perfectionism with the patient’s attempts to defend against perceived abandonment, criticism, rejection, conflict, intimacy, or a harsh self-criticism. A total of 80 adult patients were randomly allocated to 12 sessions of DRT or PST and assessed at pre-treatment, post-treatment, six months and 12 months post-treatment. The authors found that both DRT and PST resulted in moderate to large improvements in the main dimensions of perfectionism: trait perfectionism, perfectionistic self-presentation, and self-relational components. However, patients allocated to DRT experienced greater improvement in self-oriented perfectionism, all aspects of perfectionistic self-presentation, and work and social adjustment.
Perfectionism is a powerful and pernicious personality vulnerability factor for psychopathology and other dysfunctions. Both psychodynamic group treatments resulted in reductions in most dimensions of perfectionistic behaviors. However, dynamic relational group therapy (DRT) was more effective than psychodynamic supportive group therapy (PST), especially for perfectionistic traits (those stable and consistent personality factors that drive the requirement of perfection). When working with perfectionistic patients, therapists would do well to interpret unmet needs and perfectionistic behaviours as an ineffective defensive solution to fulfill these needs. This may facilitate more substantial changes, especially in deeply ingrained trait and self-representational components of perfectionism.
Hewitt, P. L., Kealy, D., Mikail, S. F., Smith, M. M., Ge, S., Chen, C., Sochting, I., Tasca, G. A., Flett, G. L., & Ko, A. (2023). The efficacy of group psychotherapy for adults with perfectionism: A randomized controlled trial of dynamic-relational therapy versus psychodynamic supportive therapy. Journal of Consulting and Clinical Psychology, 91(1), 29–42. https://doi.org/10.1037/ccp0000787
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