The intertwined path of perfectionism and self‐criticism in a client with obsessive‐compulsive personality disorder

Abstract

Psychotherapy for obsessive-compulsive personality disorder (OCPD), where perfectionism is a defining criterion, is understudied. Despite a high prevalence few evidencebased treatments are available for the presentation. Here we describe the course of a 6-month program of metacognitive interpersonal therapy with an OCPD patient with prominent perfectionism and self-criticism, which were considered primary outcomes of the case study. Therapy aimed initially at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. First, behavioral experiments were used to try and counteract perfectionism. Second, experiential techniques, such as guided imagery and rescripting, were used to help the client in connect with different, healthier aspects of the self, thus increasing personal and interpersonal wellbeing.

Building the alliance and using experiential techniques in the early phases of psychotherapy for avoidant personality disorder

“…In situations like these, MIT utilizes experiential techniques—with the goal of improving patients' self‐awareness. The aim is that through enabling the patient to re‐experience the scenario, (such as through guided‐imagery, role‐play or two‐chair work), arousal increases, enabling better access to “in the moment” inner states (Centonze et al, 2020; Cheli et al, 2020; Dimaggio et al, 2020). Here, the therapist opted for a role‐play where she played the boyfriend and Sybil was herself.…”

Perfectionism unbound: An integrated individual and group intervention for those hiding imperfections

“…Indeed, these techniques can support the patients in increasing the awareness of specific episodes, so disclosing affective experiences and automatic responses to distress. A case study on a client with prominent perfectionistic traits showed how an integrated use of experiential and relational techniques can lead to early access to maladaptive schemas and a shared conceptualization of personality functioning (Cheli et al, 2020). This case exemplified how to treat personality pathology through Metacognitive Interpersonal Therapy (MIT; Dimaggio et al, 2015, 2020).…”

Concluding commentary: Treating perfectionism transdiagnostically with an eye on the future

“…Fourth, Cheli et al (2020) exemplified MIT in the case of a 23‐year‐old female client with an obsessive‐compulsive personality disorder. Similar to Rozental (2020), Cheli and collaborators aimed to promote awareness of perfectionistic schema encouraging the client to view her ideas as hypotheses rather than the absolute truth and allowing herself to think of the same interpersonal event in different manners.…”

“…The six clinical cases differed in their way of conceptualizing maladaptive perfectionism and this was the starting point for distinct treatment plans. Some viewed maladaptive perfectionisms as (a) a maladaptive overcontrolled coping style (i.e., Cheli et al, 2020; Codd & Little, 2020; Matos & Steindl, 2020), (b) a faulty implicit emotional learning style (Vaz & Ecker, 2020), or (c) even a personality style that arises out of early relational experiences (i.e., Hewitt et al, 2020). Others, conceptualized perfectionism as a rigid and inflexible belief or schema in regard to oneself and in relationship to others (i.e., Cheli et al, 2020; Matos & Steindl, 2020; Rozental, 2020).…”

“…Technique wise, they share a combination of methods. For instance, at least three of the case studies used experiential methods (Cheli et al, 2020; Matos & Steindl, 2020; Vaz & Ecker, 2020) evidencing the blurred lines in between therapies in the search of the best mix of methods for the clients. Importantly, the authors of the current special issue merit credit for exemplifying various treatment modalities for a wide range of mental health issues, including comorbidities.…”