porcelain dolls a cognitive-behavioral approach to breaking through perfectionism and...
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PORCELAIN DOLLSA Cognitive-Behavioral Approach to Breaking Through Perfectionism and People-Pleasing In Women
Dr. Carly LeBaron, LMFT
PRESENTATION OUTLINE
What is a Porcelain Doll?
PerfectionismDefinitionHow it presents
People-PleasingDefinitionHow it presents
Contributing Gender IssuesSocializationCultural roles, rules, & expectations
Compassionate CBT Treatment Approach
PORCELAIN DOLLS
What do they look like?Demographics
What do they do?Common behavioral signs
What are their presenting problems?Depression, anxiety, EDs, low self-esteem, body image issues, etc.
Don’t get taken in by them!They will very frequently be some of your favorite clients (even though we don’t play favorites,
right?). Why?
PERFECTIONISM
DefinitionSetting excessively, sometimes impossibly, high performance standards accompanied by
overly critical self-evaluations and fears of others’ evaluations of them.
How it ManifestsHigh functioning perfectionists
Strong achievement orientationHighly Successful (straight A’s, scholarships, rapid job promotions)Pedestals, golden children
Low functioning perfectionistsLack of follow-throughFailing out of schoolQuitting before completionLosing jobs
The Core of PerfectionismIf people see who I really am, how flawed I really am, they will reject me and/or abandon me.
PERFECTIONISM
The Benefits of PerfectionismGet things doneLots of praise/reinforcementAchievementsProtection from being real
The Costs of PerfectionismParalysisExhaustionNever feeling good enoughRide the high of one achievement, but it never lastsConstantly seeking external sources of self-esteem
PERFECTIONISM
Why is perfectionism so difficult to treat and hard to beat?
Reinforced in our culture (capitalism, individualism)
Friends, family members, professors, church leadersPerfectionists serve a purpose for the rest of us
LDS contextBe ye therefore perfect…
People love a perfectionistWhy?
PEOPLE-PLEASING
DefinitionAn intense focus on behaving only in ways that please others, regardless of personal
wants/needs/opinions/thoughts and an overwhelming concern with how others perceive you.
How it ManifestsThe Yes WomanDon’t rock the boatUndifferentiatedDon’t get angryAlways be nice!!!!!!!!!!!!!! (Did I put enough exclamation points?!...)Oh, yeah, and always checking to see if what they say/think/feel is okay
The Core of People-PleasingI have to go out of my way to please people or they won’t like meI have nothing else to offer but to please others, so if I don’t please them, they won’t accept
me
PEOPLE-PLEASING
The Benefits of People-PleasingOthers respond positively to youYou make people happyYou avoid confrontationYou avoid hurting people’s feelings
The Costs of People-PleasingYour needs get ignoredYou can become a doormatYou develop resentmentTend towards passive-aggressive to get needs metWhen people refuse to be pleased, it must be your faultPeople lose respect for youYou sacrifice self growth and genuine relationships
PEOPLE-PLEASING
Why is it so difficult to treat and hard to beat?
Reinforced by conservative, traditional cultures
Reinforced by most people in our clients’ lives and our own livesPeople like it when they get what they want and people-pleasers deliver!
People pleasers are convinced that to do things any other way would be “mean,” “creating contention,” or “un-Christlike.”
Counteracting years of gender socialization
GENDER ISSUES
Women as relationship monitors
Women garner their self-esteem from success in relationshipsSuccess in relational roles
Socialized to be more attuned to social cues, social control, especially from other women
Relational aggressionMean girls, Queen Bees and Wannabes
Comparison (upward and downward)
What else can you think of?
GENDER ISSUES
GIRL RULES:Be Nice!Don’t call attention to yourself.Put others needs first.You can do better than that.Indirect queries to get needs met
Manipulation, subversive
Mind-readingEmphasis on looks, image
Other rules you can think of?Both implicit and explicit rules
SELF-OF-THE-THERAPIST
Why do I love working with this population so much?
Mary PoppinsMy externalization
Once a compliment, now an insult
What about you?Self-check
PerfectionismPeople-pleasing
TREATMENT APPROACH
Cognitive process
EVENT EVENT EVENT EVENT EVENT
MENTAL ILLNESS FILTER (DEPRESSION, ANXIETY, OCD, EATING DISORDER, etc.)
POSITIVE CORE
BELIEFS
NEGATIVE CORE
BELIEFS
FEELINGS
TREATMENT APPROACH
Core BeliefsPositive and NegativeOkay to have both, need balanceMessages from FoO, other memorable instances
Cognitive Distortions (Burns, Feeling Good)AoNTOvMFDtPJtC
MR, FT
M&MERSSL&MPe
TREATMENT APPROACH
Fight back against CDsReality Checking (All)
“Is that really true?”
Living in the Gray (AoNT)Empowerment (O)The Lawyer Technique (MF)Reinforce PCBs (DP)10 Possible Alternatives (JtC)Apples to Apples, Oranges to Oranges (M&M-Comp)Relaxing Rigidity (SS)The Confessional (ER)Would a Teenage Girl Say This? (L&M)I Have the Power! (P)
TREATMENT APPROACH
STOP, It’s Narrative Time!The importance of EXTERNALIZING
The Mask Activity
What Perfect Looks Like/Feels Like, What Real Looks Like/Feels Like
TREATMENT APPROACH
Practicing Imperfection (aka Deperfectifying)Start with little things:
Spill on purpose, don’t clean it up for 10 minutesPaint every fingernail but oneQ-tip example
Move on to bigger thingsBe late to a lunch date with a friendDeliberately flub a few words during a presentation or while talking to coworkersDon’t wear makeup for a whole day out
Dare to be Average and the Mediocre Bucket ListForget the 5- and 10-year plans, let’s get mediocre!
The Velveteen RabbitEncourage them to read it. Just do it. You’ll thank me later.
TREATMENT APPROACHAssertiveness TrainingStep 1: Convince her that assertiveness=/= being mean
Teach difference between passive, assertive, and aggressive
Step 2: Repeat step one until you are blue in the faceStep 3: Practice real life situations with her using role plays
Switch roles so she learns to be both voices
Step 4: Give her homework to practice in real life
Learning to say “No”“Let me check my schedule…”
The BacklashSome people will NOT respond well to your client’s changesPrepare her in advanceShe will feel mean initially, validate her
Others may even tell her she is being mean, process that
Remind them: “That’s more about them than it is about you.”Authority figures will be the most difficult to be assertive with
TREATMENT APPROACH
Self-Compassion and Self-ForgivenessThe crux of successful treatment with this populationSpend lots of time hereModel self-compassion, self-disclosureThe Best Friend TechniqueThe Internal Cheerleader (or Therapist)
WWCS?Permission to temporarily internalize my voice until it can become their own
Forgiveness is a process“Will the world end/anything spontaneously combust if I do X?”“Will this matter in a year? 6 months? 2 Months? Next week? Tomorrow?”
Only give it as much power as it deserves
TREATMENT APPROACH
HomeworkLet’s talk about strategery…
The cool part about every homework you EVER give a perfectionist: THEY CAN’T FAIL!!!...or is that bad?
Imperfect practice makes imperfect!
Test the watersBe ready for them to come back unhappy, in pain, scaredProvide support and encouragement
Allow them to be imperfect with you
Catch them in people-pleasing with youGive them permission to disagree, be angry, etc.
Carly Voodoo Doll
QUESTIONS OR COMMENTS
Contact Information:
Dr. Carly LeBaron, LMFT
Utah Valley Counseling
2230 N. University Parkway,
Suite 11D, Provo, UT
(801) 407-4134
(Feel free to grab one of my cards with my contact info!)