Meta-analyses conclude that cognitive behavioural therapy (CBT) for perfectionism is efficacious without addressing indices of efficacy such as reliable improvement, deterioration, dropout, and change at follow-up. We addressed this through a reanalysis of the 16 randomized controlled trials included in Galloway et al. (2022), Robinson andWade (2021), andSuh et al. (2019). At posttreatment, small-to-large effects favouring CBT were found for certain perfectionism measures: high standards (g = −0.40), doubts about actions (g = −0.49), personal standards (g = −0.50), concern over mistakes (g = −0.85), and clinical perfectionism (g = −0.97). Small-to-medium posttreatment effects were found for symptoms of eating disorders (g = −0.29), anxiety (g = −0.37), and depression (g = −0.62). In contrast, self-oriented perfectionism (g = −0.60; 95% CI [−1.96, 0.78]), other-oriented perfectionism (g = −0.36; 95% CI [−1.15, 0.43]), socially prescribed perfectionism (g = −0.53; 95% CI [−1.58, 0.51]), perfectionistic cognitions (g = −0.70; 95% CI [−1.57, 0.17]), discrepancy (g = −0.48; 95% CI [−1.83, 0.87]), life satisfaction (g = −0.59; 95% CI [−1.02, 0.01]), and self-esteem (g = −0.53; 95% CI [−1.25, 0.18]) did not differ between treatment and control conditions. Risk ratios for reliable improvement were significant for perfectionistic cognitions (RR = 1.46), concern over mistakes (RR = 2.36), and clinical perfectionism (RR = 3.07). Dropout was 27.0% and higher in treatment than control conditions (RR = 1.78). At follow-up, all between-group effects were nonsignificant. Findings support the efficacy of CBT for certain perfectionism features while underscoring crucial limitations and areas for improvement. Public Significance StatementThe importance of evaluating treatments for perfectionism is crucial given the deleterious effects of this personality variable. Although there are indications that CBT for perfectionism is efficacious, the current work indicates that a substantial proportion of participants do not experience reliable posttreatment improvements. Moreover, for those who experience improvements, it is unclear how much improvement extends beyond posttreatment. Dropout also appears higher in treatment conditions than in control conditions, suggesting that CBT for perfectionism might not be well tolerated by many individuals with perfectionism. Developing and refining treatment for perfectionism is urgently needed.

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Objective: This randomized controlled trial investigated the efficacy of group dynamic-relational therapy (DRT) relative to group psychodynamic supportive therapy (PST) in treating perfectionism and improving psychological functioning. Hypothesis: Psychodynamically informed therapies, particularly DRT, will be efficacious in treating perfectionism and functioning outcomes. Method: Based on a comprehensive conceptualization of perfectionism, 80 community-recruited, highly perfectionistic individuals were randomly allocated to 12 sessions of group DRT (n = 41; 5 groups) or group PST (n = 39; 5 groups). Patients completed measures of trait perfectionism, perfectionistic self-presentation, perfectionistic cognitions, symptom distress, life satisfaction, and work and social adjustment at pre-, mid-, and posttreatment and 6 months posttreatment. Results: Multigroup latent growth curve modeling revealed significant (p < .05) decreases in all perfectionism components and improvements in all functioning outcomes from pretreatment to 6-month follow-up in both DRT and PST. Likewise, analyses revealed substantial reliable improvement across conditions for all perfectionism components. Last, moderate-to-large between-group differences favoring DRT over PST were found for self-oriented perfectionism, perfectionistic self-promotion, nondisplay of imperfection, nondisclosure of imperfection, and work and social adjustment. Conclusion: Findings provide evidence for the use of psychodynamic approaches in the treatment of perfectionism and support the relative efficacy of DRT for components of perfectionism. What is the public health significance of this article?This study found evidence supporting the efficacy of psychodynamically informed treatments for perfectionism, a pernicious vulnerability factor in many disorders and dysfunctions. Results also indicated that dynamic-relational therapy was superior to psychodynamic supportive therapy for most components of perfectionism and work and social adjustment. The findings support the importance of psychodynamic group psychotherapy approaches, and dynamic-relational therapy in particular, in treating perfectionism.

Objective: Despite the known association between therapeutic alliance ruptures and outcomes in individual therapy, there is almost no research on the topic in group therapy. Group therapy is inherently more complex such that interactions occur at multiple relational levels, including member-to-member, member-to-therapist, and member-to-group. Ruptures may occur at any of these levels, and therapists or group members may initiate repair strategies. We used an evidence-based case study to evaluate the utility and feasibility of using the Rupture Resolution Rating System (3RS) in group therapy. Method: Participants were 8 members with perfectionism and 2 therapists in a middle session of group therapy. We coded ruptures and repairs with the 3RS, the relational level of the group's interactions, and the actor and target of rupture or repair behaviors. Perfectionism outcomes were assessed pre-and posttreatment. Results: Members' perfectionism showed clinically meaningful improvement. The group therapy session had both withdrawal and confrontation ruptures at each relational level of the group, with half of all ruptures occurring between members. Therapists initiated most of the repair strategies, but members initiated about one third of repairs. Conclusions: The 3RS may be useful to code ruptures and repairs in a group therapy context. Modifications were necessary so that the relational level of group interactions and the target of the behavior (member, therapist, group) were concurrently coded. This concurrent coding strategy makes use of the richness of 3RS coding, accounts for the complexity of group therapy interactions, and may be useful to inform clinical practice and research.