Slide 1

Barbara Morrell, Ph.D. Brigham Young University Presented at the AMCAP Spring Convention April 3, 2008 Slide 2 Perfectionism is not a quest for the best. It is a pursuit of the worst in ourselves, the part that tells us that nothing we do will ever be good enough that we should try again. Julia Cameron Slide 3 Heresy Seven: There are those who believe we must be perfect to gain salvation. This is...a doctrinal misunderstanding...Faithful members of the Church will be saved, even though they are far from perfect in this life...[Joseph Smith] taught that there are many things to be done, even beyond the grave, in working out our salvation. Bruce R. McConkie The Seven Deadly Heresies, (1980) Slide 4 Perfectionists are apt to be especially familiar with the self-conscious emotions [i.e. shame, guilt, embarrassment, pride] because they focus so much energy on self-evaluation. Perfectionists do not just set high, often rigid, standards for themselves in a particular domain; they are oriented toward the process of evaluation. Life is a series of quizzes, tests, and final exams, and their name is always at the top of the report card. (Tangney, 2002, p. 199) Slide 5 How do clients learn Perfectionism? Slide 6 Sources of Perfectionism American/Asian/other Cultures Competition Mentality Worth based on achievements, looks, money, success Mormon Culture Distortion of Doctrine of Eternal Perfection Influence of American culture Negative feedback in childhood Human Nature/Natural Temperament Anxiety: Biological Predisposition Attachment Issues/Abuse/Neglect Slide 7 Doctrine of Eternal Perfection vs. Cultural Perfectionism Language: Matt 5:48 Be ye therefore Perfect vs. Be ye therefore complete and fully developed (in the eternities). Two sets of undifferentiated values: Eternal and Material Equating behavior with the essence of the self: bad behavior = bad person All things become moral: grades, looks, income, talents, etc. Slide 8 The LDS Therapists Dilemma: How do we facilitate clients in modifying perfectionism as a therapist, not as a teacher, leader, or church member? Slide 9 Potential Pitfalls for LDS Therapists working with LDS Clients Assuming we understand a clients worldview and values because they are LDS (or another religion) Violating ethics by entering a clients spiritual/religious world without permission Alienating a client who is struggling with their beliefs and/or affiliation Feeling responsible for clients to make good choices and becoming another voice of authority Imposing Mormon cultural ideals or shoulds on clients because of our own unexamined cultural influences Slide 10 Helping Clients Teach Themselves Correct Doctrine: Guidelines Wait for clients to raise Spiritual/Religious concerns Ask about clients beliefs and worldview and validate their individuality and agency Dont make assumptions about what clients want spiritually and religiously Clarify our role as a therapist, not a doctrinal authority Dont assume we have the answers for spiritual dilemmas Follow the clients lead Ask permission to use spiritual interventions, even when clients raises spiritual issues Slide 11 Understanding the Impact of Perfectionism on Clients Assess clients view of how self-critical or perfectionistic tendencies affect them: level of self-awareness Assess severity of impact of clients perfectionism on psychological well-being and functioning. Seek to understand the origins of clients perfectionism to help with treatment planning. Slide 12 Influences on Perfectionism: Continuum of Severity Competitive Cultural Environment (in and out of church settings) Peer Rejection Perceived Failure Family Examples, Expectations and/or Negative Feedback Attachment/ Trauma Issues (profound underlying negative sense-of -self) Slide 13 Cultural Perfectionism: Chicken or Egg? Does American/Mormon culture breed Perfectionism or do individuals who feel a sense of inherent badness or worthlessness project their feelings about themselves onto the doctrine? Slide 14 Shame vs. Guilt People experiencing guilt often are motivated to confess, apologize, or atone. In contrast, when people feel shame, our key concern is with our self, as a person. Feelings of shame involve a painful negative scrutiny of the entire self-a feeling that I am an unworthy, incompetent, or bad person. They feel worthless and powerless, and they feel exposed. As in guilt, feelings of shame can arise from a specific behavior or transgression, but the...bad behavior is taken not simply as a local transgression, requiring reparation or apology; rather, the offending or objectionable behavior is seen as a reflection, more generally, of a defective, objectionable self. (Tangney, 2002, p. 201) Slide 15 Attachment and the Self Attachment bonding is critical to development of the right brain systems involved in processing emotion, modulation of stress, self- regulation, and the early origins of the bodily-based implicit self. ( Schore, 2003) Through constant interactions from birth, the caregiver is a mirror for child to develop his/her sense of self. (Kohut in Cashdan, 1988) Internalized negative and positive interactions become the basis for sense of self: parental negative voice becomes internalized (Melnick, 1995) Slide 16 Mother-Infant Communication and Attachment Communication happens Right Brain to Right Brain 80% of Right and Left-handed mothers cradle infant in left armeasier access to left ear and face (right brain) During eye-to-eye transactions the infants maturing right hemisphere is psycho biologically attuned to the output of the mothers right hemisphere. (Schore, 1995) Left side of face shows emotions: Van Gogh Self-Portrait Slide 17 Slide 18 Focus of Therapy for Attachment Issues Right Brain (non-verbal) Relational connection Corrective Emotional experience Neuroplasticity: Brain can rewire healthier attachment patterns Sense of self can develop more positively (Schore, 2005) Skills Training: DBT, ACT: Emotional Regulation, Distress Tolerance, Mindfulness, etc. Slide 19 Implications for Therapy For severely perfectionistic clients a frontal attack on their perfectionism may feel like attack on the self. Positive feedback about their worth may generate confusion and emotional pain instead of relief Clients may have intense fear of change The therapeutic relationship may be difficult to build and maintain (Blatt, et al 2002) Slide 20 General Treatment Considerations for Perfectionism Explore, understand, empathize with feelings of worthlessness before challenging them: Challenge is inherently non-validating Process fears of change: who will I be?; loss of motivation & achievement; what if Im wrong? what will others think? Shame vs. Guilt or Remorse: Shame indicates deep-seated negative sense of self Axis I Disorders: Anxiety and Depression must often be addressed before perfectionism can be tackled Slide 21 Questions and Feedback to Promote Self-Exploration & Understanding You seem really hard on yourself. How do you feel about that? How does it affect you? How does it help/hurt you to have such high expectations? How does being hard on yourself affect your anxiety/depression? Is that something you want to work on changing? Where did you learn to be so self-critical? What are you earliest memories of feeling inadequate? What are your fears of changing? What would you lose? How would things be different? What would you like about that? Im not sure I understand your guilt for getting Bs. Do you believe grades can make you more or less righteous? What do you believe makes a person important or worthwhile? It sounds like you believe in unconditional worth for others, but not for yourself. How fair is that? What gets in the way of believing in your worth? Slide 22 Questions & Feedback cont. So you believe that something is wrong with you because you cant do it all? That sounds very painful. What is it like for you? How possible is for anyone to do it all perfectly? Why not? (If they raise LDS doctrine of Perfection) Does LDS doctrine say God expects you to be perfect right now? Is there anything you know that tells you that might not be true? How do you think God sees your weaknesses? It sounds like you judge yourself more harshly than God does. You really hate to be human dont you? Me, too. What is painful about making mistakes for you? How would you like to see yourself? How would you like to view your mistakes and weaknesses? Its really hard to change things youve believed for many years. It can be like fighting a tidal wave. It seems like you feel caught between the eternal perspective and the worldly perspective of your worth. What would you like to base your life on? How would things be different if you did? Slide 23 Changing Beliefs (Not just Thoughts) Focus on Negative/Perfectionistic beliefs as learned and the process of unlearning them: Normal to reach adulthood with irrational beliefs, but dont have to keep believing them. Teaching self correct doctrine Differentiate behavior and achievement from personhood: Instead of better and worse think better off and worse off (positive and negative consequences) Deepening New BeliefsFrom Head to Heart: Use of analogies to understand process of change and growth: Almas seed, learning to play the piano, etc. Internalizing in a way that works for individual clients: Reading, talking, thinking, writing, praying, feedback from others. Slide 24 Use of Scriptures & Religious Quotes Pros of using scriptures: May be very appropriate if client is comfortable with it(may help to ask if they are interested in seeing a scripture that relates to the point of doctrine they are wrestling with). Can be used in a way to help clients teach themselves How is this different from how you have been seeing this issue? Cons of using scriptures: Can shut down process of finding own answers if seen as the answer or solution, or that the therapist is a church authority. Might seem too simplistic or prescriptive. Can be very alienating to some clients who are struggling. Slide 25 Using a Developmental Perspective Help clients understand how a negative sense of self develops Children think in black and white-- believe the negative feedback they receive, so view self as bad Children tend to blame themselves for bad things and think it is their fault Encourage clients to view selves in the process of normal Development: Clarifying Values (Chickering): Highlighting contradictions between conflicting sets of values and beliefs (Mormon Culture vs. Doctrine vs. Materialism) and making conscious choices Process of Separation/Individuation/Identity Development (Chickering) From Dualistic (Good/Bad) view of self and others to more complex view (Perry) Young Adulthood as the time to sort through beliefs learned in childhood and to teach oneself correct doctrine or see what is true with adult eyes. A perceived weakness is not a flaw, but something we havent yet learned to do. Slide 26 Treating Attachment & Trauma-Related Perfectionism Emotional/Trauma processing: Negative, perfectionistic beliefs about self are often embedded in memories and/or family dynamics. Work on understanding they survived as best they could and that adult/peer/perpetrator treatment of them wasnt about them. Self-care: Learn from experience that attending to ones own needs is important. Re-parenting Oneself: How would an unconditionally loving parent talk to you about this weakness or mistake? Attending to outside Relationships: People learn self-love in supportive relationships: Friends, Mentors, Bishops, Spouses & dating partners, etc. Slide 27 Skills, Awareness, Interventions Acceptance Commitment Therapy (ACT): Focus on Mindfulness & Self-awareness, Acceptance & Tolerance of Distress & Pain DBT Skills Training: Mindfulness, Emotional Regulation, Distress Tolerance, Interpersonal Effectiveness Positive Psychology Interventions Bibliotherapy Relaxation and Imagery for Ego-strengthening: http://ccc.byu.edu/counseling/skills.php Slide 28 Case Examples Melissa: Then I would have a choice. Mark: Question: Do you believe the Lord grades on the curve? His answer: I want to be the first one into the Celestial Kingdom. Sam: Im going to cure myself of Perfectionism and Masturbation by tomorrow. Melanie: Im really starting to get that it wasnt about me. Slide 29 Perfectionizm Bibliotherapy Burns, David, (1980). Feeling Good: The New Mood Therapy, Signet: New York. Dew, Sheri (2004). No One Can Take Your Place, Deseret Book: Salt Lake City Holland, Jeffrey R. The Other Prodigal. Ensign, May, 2002, 62. http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=f318118dd536c010VgnVCM1000 004d82620aRCRD&locale=0&sourceId=13d68d00422fe010VgnVCM100000176f620 a____&hideNav=1 http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=f318118dd536c010VgnVCM1000 004d82620aRCRD&locale=0&sourceId=13d68d00422fe010VgnVCM100000176f620 a____&hideNav=1 McConkie, Bruce R. (1980). The Seven Deadly Heresies, http://speeches.byu.edu/reader/reader.php?id=6770 Nielsen, Perfection Pending. Ensign, November 1995 http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=2354fccf2b7db010VgnVCM1000 004d82620aRCRD&locale=0&sourceId=453c6e9ce9b1c010VgnVCM1000004d82620 a____&hideNav=1 http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=2354fccf2b7db010VgnVCM1000 004d82620aRCRD&locale=0&sourceId=453c6e9ce9b1c010VgnVCM1000004d82620 a____&hideNav=1 Okazaki, Chieko, (2002). Being Enough, Bookcraft: Salt Lake City. Slide 30 Bibliotherapy cont. Robinson, Stephen, (1992). Believing Christ, Deseret Book: Salt Lake City. Samuelson, C. O. What Does it Mean to be Perfect New Era, January, 2006, 10-13. http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=024644f8f206c01 0VgnVCM1000004d82620aRCRD&locale=0&sourceId=ca81092480e 6c010VgnVCM1000004d82620a____&hideNav=1 http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=024644f8f206c01 0VgnVCM1000004d82620aRCRD&locale=0&sourceId=ca81092480e 6c010VgnVCM1000004d82620a____&hideNav=1 Seligman, Martin, (1991). Learned Optimism, Pocket Books, New York. Seligman Positive Psychology Website: http://www.authentichappiness.sas.upenn.edu/Default.aspx http://www.authentichappiness.sas.upenn.edu/Default.aspx Ulrich, Wendy (2007) Forgiving Ourselves: Getting Back Up When We Let Ourselves Down, Desert Book: Salt Lake City Slide 31 Brothers and sisters, I testify that no one of us is less treasured or cherished of God than another. I testify that He loves each of us insecurities, anxieties, self-image, and all. He doesnt measure our talents or our looks; He doesnt measure our professions or our possessions. He cheers on every runner, calling out that the race is against sin, not against each other. Jeffrey R. Holland The Other Prodigal Ensign, May, 2002 Slide 32 References Blatt, S. J. & Zuroff, D. C. (2002). Perfectionism in the therapeutic process. In G.L. Flett & P.L. Hewitt (Eds.), Perfectionism: Theory, Research, and Treatment (pp.393-406). Washington, DC: APA Bowlby, J. (1988). A secure base: Parent-Child attachment and healthy human development. New York: Basic Books, Inc. Cashdon, S. (1988). Object relations therapy. New York: W.W. Norton & Company: Melnick, S. (2005). Trauma and Attachment Presentation at the Harvard Medical School Attachment and Related Disorders conference, Boston, May 7, 2005. Shore, A. (2003). Affect disregulation and disorders of the self. New York: Norton. Shore, A. (2005). Recent Advances in the Neurobiology of Attachment: Implications for Interventions and Prevention. Presentation at the Harvard Medical School Attachment and Related Disorders conference, Boston, May 6, 2005. Tangney, J.P. (2002). Perfectionism and the Self-Conscious Emotions: Shame, Guilt, Embarrassment, and Pride. In G.L. Flett & P.L. Hewitt (Eds.), Perfectionism: Theory, Research, and Treatment (pp.393-406). Washington, DC: APA Contact Information: barbara_morrell@byu.edu