Therapy for The Recovering Perfectionist
As a therapist working and living in New York City, I meet a lot of people who are used to expecting a lot from themselves.
Many of my clients work in demanding fields, like law, finance, or medicine, trying to establish themselves in one of the most competitive cities in the world. Others are students striving for perfect 4.0 GPAs to set them apart from their classmates.
They may have come to therapy because they feel stressed or anxious most of the time. Even when things are going well, they struggle to feel proud of their achievements or optimistic about their futures. A compliment from a boss, teacher, or coworker may offer a moment of relief, but a small mistake can occupy their thoughts for days. Clients assure me that they “know they aren’t saving lives,” yet feel intense pressure when sending emails or showing up to meetings. For many, that pressure follows them into meals, exercise routines, and everyday conversations.
It’s no surprise that these clients openly identify as perfectionists.
Then there are the clients who are surprised when I use the word perfectionism. They don’t recognize themselves in the image of someone who has everything together: the perfect Type A achiever who charges through tasks with ease. Instead, they see the projects they haven’t started, the decision they keep putting off, or the to-do list they’ve already rewritten three times.
“How can I be a perfectionist,” they ask, “when I’m not getting anything done?”
Perfectionism isn’t measured by how perfectly you perform. The Centre for Clinical Interventions describes perfectionism as “the relentless striving for extremely high standards”, judging your self-worth by your ability to meet them, and continuing to pursue those standards despite consequences such as anxiety, persistent stress, or social isolation (Fursland et al., 2009, p. 2). You can be caught in this pattern whether you’re exceeding everyone’s expectations or feeling too overwhelmed to begin.
Having goals and caring about your work can be a meaningful way to approach life. But perfectionism becomes damaging when there’s little room to adjust your expectations, make mistakes, or feel worthwhile outside of what you accomplish. A disappointing outcome can start to feel like evidence of a disappointing self.
If I ease up, will everything fall apart?
One of the most exhausting aspects of perfectionism is that the standard keeps changing. If you fall short, you may take it as proof that you didn’t work hard enough or are a failure. If you succeed, you may decide the task was too easy to begin with or didn’t really count.
From inside that cycle, easing up can feel risky. When I talk with clients about changing the standards they hold themselves to, some worry that everything they’ve worked for will come crashing down.
If I don’t triple check my work, will I make a careless mistake and look like a fool? If I take a day off from working out, will I lose all my progress? If I stop pushing myself, will I stop achieving altogether?
Sometimes there’s a more personal question underneath: If I’m not the successful one, the helpful one, or the person who never lets anyone down, what makes me worth knowing?
I can understand why someone might want relief from this anxiety while feeling protective of the habits that contribute to it. Being kinder to yourself can sound appealing in theory but irresponsible in practice.
In our work together, I want us to be able to talk openly about that ambivalence. You may worry about losing the drive that has helped you accomplish things you’re proud of. Or, if you’ve been putting off goals that matter to you, easing the pressure may feel like giving up on ever reaching them. We can take those fears seriously while also asking what that pressure is costing you. Which standards still feel worth the effort? Which leave you exhausted, stuck, or unable to enjoy what you’ve accomplished?
What might therapy look like for the recovering perfectionist?
There is no one size fits all approach in therapy. Perfectionism can underlie different mental health concerns, including anxiety, depression, relationship concerns, and problems around eating or body image (Egan et al., 2011; Limburg et al., 2017). The person who works late every night and the person who avoids opening their laptop may share the same fear of falling short, but need different support.
Here are a few ways we might approach perfectionism together in therapy:
Making room for identity beyond achievement
We may begin by exploring when being impressive, useful, or undemanding became so important. Perhaps achievement brought recognition, mistakes led to criticism, or being reliable helped you feel secure in relationships. Understanding that history can help us make sense of why mistakes feel so personal now.
You may know exactly what you want from your career but struggle to name what you enjoy when there’s no goal attached. Rest might feel like something to earn, a hobby like another skill to master, and relationships like places where you must always be helpful or easy to be around.
I’m interested in getting to know the parts of you that don’t fit neatly on a résumé or keep everyone around you happy. We might talk about interests you’ve set aside because you weren’t particularly good at them, or things you’d like to try but can’t quite justify spending time on. That could mean dancing, making art, or doing something just because it sounds fun. It could also mean having an afternoon with nothing planned and noticing what happens. What interests you when joy and curiosity get a say?
Questioning the rules you live by
Perfectionistic thinking can sound convincing, especially when it has been with you for a long time.
I should be able to handle this without help. If I make a mistake, people will lose confidence in me. If I can’t do it well, there’s no point in starting.
Cognitive behavioral therapy, or CBT, can help you recognize patterns such as assuming the worst, thinking in all-or-nothing terms, or holding yourself to a long list of “shoulds.” We can examine what you’re predicting, consider the evidence, and look for a response that is both more realistic and more compassionate.
We can also make plans to try small behavioral experiments outside of sessions. You might send a routine email after only one careful review, speak up in class without rehearsing, or let a non urgent task wait until tomorrow. It could be as simple as leaving your clothes over the back of a chair after a late night instead of putting them away immediately.
If your mind jumps to Once I let this slide, everything will pile up, we can investigate this fear further and see what happens. Does giving yourself a break tonight actually make it harder to put things away tomorrow? What is it like to leave something unfinished and still let yourself go to bed?
Noticing what happens in your body
Many of my clients already understand a great deal about their perfectionism. They know that a routine email probably doesn’t need another review. Yet knowing that doesn’t necessarily make it feel easier to press send.
Alongside talking things through, we can use somatic, or body-focused, work to notice how perfectionism shows up physically. You might hold your breath while rereading an email, tense your shoulders when someone offers feedback, or feel your face grow hot during an awkward pause in conversation.
Together, we can slow down and pay attention to the sensations, emotions, and thoughts that come up in these moments. Depending on what feels helpful, we might practice grounding, gently releasing tension, or staying with a feeling without immediately checking, apologizing, or trying to fix something.
You don’t have to feel completely calm to change how you respond to perfectionist pressure. The aim is to create more room to choose your response, even when discomfort is still present, slowly freeing you from the bonds of perfectionism on a body based level.
Letting go of being the “gold-star” therapy client
Perfectionism can follow you into the therapy room, too. You may worry that you aren’t interesting or thoughtful enough, find yourself rehearsing what to say before a session, or feel anxious when you don’t have something prepared. If social situations often leave you wondering how you came across, you may find yourself doing the same in therapy: Did that make sense? Am I repeating myself? Is my therapist tired of hearing about this?
These worries can reflect what’s called socially prescribed perfectionism: the sense that others expect you to be perfect and will judge you harshly if you fall short (Rozental, 2020). In therapy, you might relate to your therapist as you would a boss or teacher, feeling that you need to impress them with your insights or progress. Or the pressure may feel more like it does in friendships: wanting to be liked, worrying about being boring, or holding back because you don’t want to seem difficult or needy.
That fear of judgment can make it difficult to share the things you most want help with, especially when therapy becomes more vulnerable. Talking about the pressure to be a “good” client can become part of the work. The therapy relationship offers a place to practice being less rehearsed, expressing disagreement, and letting yourself be seen when you don’t have everything figured out.
Sticking with therapy even when it gets hard
Perfectionism can also make it difficult to give therapy a consistent place in your life. A last-minute meeting feels impossible to decline, a friend or family member needs a favor, or unfinished work seems more pressing than your appointment.
There are plenty of practical reasons that attending therapy can be difficult. But if you notice that your appointments are regularly the first thing to go when someone else needs you, that may be worth exploring together. Do your own needs tend to wait until everyone and everything else has been taken care of?
If this pattern comes up, we can name it together and explore what boundaries would help you make time for your own care, even when other people are asking for your attention.
Allowing change to be imperfect
It’s possible to turn recovering from perfectionism into another project you feel compelled to get right. You might catch yourself thinking that you should be better at resting by now, or that you’ve undone your progress because you spent an evening overthinking.
Those moments can become part of the work. Over time, change might look like recovering from a mistake with less self-punishment, asking for help sooner, or enjoying something without needing to excel at it. You may still feel the familiar perfectionist pressure, but find that it has less influence over what you do next.
If you recognize yourself in this post, now may be a good time to explore perfectionism in therapy. I offer virtual individual therapy for adults across New York State. You’re welcome to schedule a free consultation to talk about what you’re looking for and see if we might be a good fit.
References
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31(2), 203–212. https://doi.org/10.1016/j.cpr.2010.04.009
Fursland, A., Raykos, B., & Steele, A. (2009). Perfectionism in perspective: Module 1—What is perfectionism? Centre for Clinical Interventions. https://www.cci.health.wa.gov.au/~/media/CCI/Consumer-Modules/Perfectionism-in-Perspective/Perfectionism-in-Perspective---01---What-is-Perfectionism.pdf
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology, 73(10), 1301–1326. https://doi.org/10.1002/jclp.22435
Rozental, A. (2020). Beyond perfect? A case illustration of working with perfectionism using cognitive behavior therapy. Journal of Clinical Psychology, 76(11), 2041–2054. https://doi.org/10.1002/jclp.23039
