The perniciousness of perfectionism in group therapy for depression: A test of the perfectionism social disconnection model.

Abstract

Half a century of theoretical accounts, case histories, and evidence implies perfectionism limits the success of psychotherapy and makes it hard for people to participate in and benefit from close relationships. Likewise, intimate relationships are crucial determinants of the success of treatment. However, the extent to which specific types of relationships explain why perfectionism leads to a poorer treatment outcome is unclear. Objective: We addressed this by, first, testing whether the perfectionism traits of self-oriented, other-oriented, and socially prescribed perfectionism hindered symptom reduction in group psychotherapy for depression and, second, assessing the mediating role of romantic love, friendships, and familial love on the effects of perfectionism traits on change in depression. Method: Psychiatric patients (N = 156) enrolled in short-term post-discharge group CBT for residual depression completed measures of perfectionism at pre-treatment, romantic love, friendships, and familial love at post-treatment, and depression at pre-and post-treatment. Results: Multilevel modeling showed that otheroriented and socially prescribed perfectionism were associated with lower post-treatment reductions in depression over treatment and path analysis revealed self-oriented, other-oriented, and socially prescribed perfectionism indirectly predicted lower post-treatment reductions in depression through a perceived lack of quality friendships. Conclusion: Results lend credence and coherence to the Perfectionism Social Disconnection Model in a clinical context and underscore the importance of taking extratherapeutic social disconnection into account when treating perfectionistic patients.

Patient perfectionism and clinician impression formation during an initial interview

“…Specifically, the relationship between patients’ pre‐treatment perfectionistic attitudes and treatment outcome could be explained by patients’ contribution to therapeutic alliance and patients’ satisfaction with their social network (Shahar, Blatt, Zuroff, Krupnick, & Sotsky, 2004). More recently, Hewitt et al (Advance online publication) found all three dimensions of trait perfectionism (i.e., self‐oriented perfectionism, socially prescribed perfectionism, and other‐oriented perfectionism) indirectly hindered symptom reduction in group treatment for depression through a perceived lack of quality friendships.…”

“…Though patient perfectionism has been implicated in therapeutic alliance (Shahar et al , 2004) and treatment success (Blatt et al , 1998; Hewitt et al , Advance online publication), there is a paucity of research on when and how patient perfectionism impedes the development of the therapeutic alliance. While some researchers suggest patient perfectionism has a negative impact on the quality of the alliance later in treatment (e.g., Blatt et al , 1998; Zuroff et al , 2000), others demonstrate that patients high in perfectionism may already harbour negative or unrealistic expectations of therapy even before the initial clinical encounter (Hewitt, Habke, Lee‐Baggley, Sherry, & Flett, 2008; Shannon, Goldberg, Flett, & Hewitt, 2018; Zuroff, Shahar, Blatt, Kelly, & Leybman, 2016).…”

“…Against this background, we aimed to build upon and extend the literature (e.g., Hewitt et al , 2008; Hewitt et al , Advance online publication; Shahar et al , 2004; Whelton et al , 2007; Zuroff et al , 2016) on perfectionism in the therapeutic context by assessing clinicians’ perceptions of patients with elevated perfectionism following an initial clinical interview. We utilized the dataset reported in Hewitt et al (2008).…”

Struggling with perfectionism: When good enough is not good enough

“…Perfectionism is more than a problem per se, as it has been found related to poor psychotherapy outcome (Shahar et al, 2003; Zuroff, Chen, Smith, Zhang, Habke, Flett & Mikail, 2000), possibly due to disruptions with the therapeutic alliance (Hawley, Ho, Zuroff, & Blatt, 2006; Hewitt et al, 2020). One study found that other‐oriented perfectionism played a role in premature discontinuation of treatment for cocaine abuse (McCown & Carlson, 2004).…”

“…Therapy should not simply focus on reducing the client's symptoms (Hewitt et al, 2020). Central to their struggles, perfectionists often view themselves as inferior, both in terms of performance and moral standards, which creates a fear of making a mistake or receiving criticism and make them prone to experience shame when they think their flaws have been unmasked (Jahromi, Naziri, & Barzegar, 2012) or feelings of guilt when they felt they caused suffering (Dimaggio, Ottavi, Popolo, & Salvatore, 2020).…”