CBT Therapy Case Study - Perfectionism
Perfectionism
Background
Lizzy has always liked things done in a particular way. She has cared a bit too much about presentation since she was a child. When she was little this was her handwriting and drawings, then as she got older it was her outfits and how she organised her home. She has received lots of high praise over the years for her attention to detail, her meticulous nature, her pretty and beautiful handiwork. Over time she started to expect herself to always meet these standards, and anything less than this no longer felt good enough.
She’s kept her perfection hidden from others, not wanting them to know she re-wrapped their gift 3 times to get it to look right, or did 10 versions of the drawing before the one she let her teacher see. This has led to cycles of burnout a few times in the past – approaching coursework submission on her degree, when completion dates approached in her previous employed job, and has already burnt out a couple of times since having her own business.
Lizzie had 1 episode of past therapy when she was in her final year at university. She googled for Therapy for Work Stress and came across my website, not realising until after her assessment that her main problem was Perfectionism.
Presenting problem
Lizzy* is 29 years old and is self employed as a creative producing items she sells online and locally. She lives alone in Altrincham and has a local studio. Whilst she has been creating and selling for over 5 years now, her work is starting to give her increased feelings of anxiety and stress as she attempts to produce ‘perfect’ items every single time.
Despite putting in more time, and becoming more obsessive, she is becoming more dissatisfied with her work. At times she is procrastinating doing her work to avoid these feelings of anxiety and disappointment in herself, and at times she is discarding completed items as not being good enough.
As a result, her productivity has significantly reduced, and her lead time for orders keeps going up and up. She realises neither is sustainable so decided to reach out for help.
Assessment
During our assessment appointment, it became clear quickly that Perfectionism was affecting multiple areas of Lizzy’s life.
Here are some of the examples:
- Discarding any work product with imperfections, no matter how small.
- Procrastinating making products as it had started to take so long to complete 1 item.
- Offering many slightly variations of products to ensure the customer always got exactly what they wanted.
- Any customer complaints (whether valid or not) were responded to with an apology and full refund.
- Responding to customer enquires was taking longer than it should as she obsessed over the wording.
- She had a pile of discarded diaries and notebooks because she preferred new ones that only contained neat writing.
- There was a build-up of chores at home that were being put off because she didn’t have time to do them properly.
- She struggled to let others help her as they didn’t do things properly.
- Card writing and gift wrapping had become time consuming as she wanted each one to look special.
- She was becoming frustrated with cooking because despite following a recipe, it didn’t turn out the exact same each time.
Treatment
Lizzy completed 8 CBT Therapy sessions booked fortnightly. She alternated between in person and Zoom therapy sessions to fit better around work life.
Treatment focused on:
- Increasing her self-awareness.
- Tackling her skewed self-perception – we did this by exploring strategies for black and white thinking.
- Adjusting her expectations of herself – we identified and challenged all her ‘I should ….’ ‘I shouldn’t …’ type messages to move towards a more balanced approach.
- Introducing self-compassion approaches to allow her to accept and tolerate her limitations as a human, and be more compassionate to herself about this.
- Intercepting Procrastination cycles – Lizzy experimented with new approaches including learning how to start something you can’t finish, and stop when it’s good enough.
- Overworking – we introduced health work life balance boundaries, to reduce her stress levels and develop a more sustainable approach, alongside looking at workload management strategies.
- Making space for the wins – we introduced a creative approach for Lizzie to celebrate her wins, and to give herself praise that wasn’t connected to her perfectionism.
- She struggled to let others help her as they didn’t do things properly.
- Card writing and gift wrapping had become time consuming as she wanted each one to look special.
- She was becoming frustrated with cooking because despite following a recipe, it didn’t turn out the exact same each time.
Once we completed this work, we then moved on to setting some experiments. Now Lizzie was thinking differently, and beginning to change how she approached work, we wanted to make sure this continued through to benefit her business.
Example behavioural experiments we did:
- She experimented with reducing her product range and was surprised that her income was only marginally impacted, but her work hours were significantly reduced.
- An online sale of discounted slight imperfect products has begun, and they are becoming some of her fastest selling items.
- Lizzy has committed to continuing with a diary or notepad until it’s end, so far so good.
- Email templates have been developed, and she is beginning to automate responses to cut down her admin time.
- Lizzy recently gave cards and gifts to loved ones without excessive time spent on them. She recognises she did feel the need to apologise to them, but their reassurance was helpful to make further progress next time.
Future areas of work:
Lizzie has made huge progress with Overcoming Perfectionism, and her business has had significant benefits in productivity and profitability.
She has decided to continue with some self-guided therapy sessions using a template we developed, to help her to continue with experiments and work on changing her thinking.
She plans to continue this for a few months, then return for top up sessions ad hoc.
* This is a fictionalised client that takes little elements from many clients I’ve worked with over many years to demonstrate an example of a client’s problems I work with and what therapy offers.
