“You are already all you need to be”: A case illustration of compassion‐focused therapy for shame and perfectionism

Abstract

This paper presents the case of a 28-year-old woman diagnosed with major depressive disorder, with strong features of perfectionism, shame, and self-criticism, treated via 12 sessions of compassion-focused therapy (CFT). CFT is an integrative therapeutic approach that draws upon evolutionary psychology, attachment theory, and applied psychological processes from neuroscience, clinical and social psychology. The effectiveness of compassion focused approaches with perfectionism and self-criticism across a range of clinical disorders is becoming increasingly wellestablished. Given this mounting evidence, a four-phase, 12-session CFT treatment plan was developed for this case: (1-2) establishing the therapeutic relationship; (3-4) psychoeducation regarding the evolutionary model of compassion; (5-8) compassionate mind training and skills development; (9-11) working with perfectionism, shame, and self-criticism. A follow-up session focused on envisioning a compassionate future. Therapeutic process and clinical outcome will be discussed, as well as implications for using CFT in clinical practice, especially where perfectionism, shame, and self-criticism are part of the clinical presentation.

A case report of compassion‐focused therapy for distressing voice‐hearing experiences

“…For example, when a voice was saying “You can't cope. You'll be permanently mad and will never come back,” the client practiced responding with empathy and compassion for what might be behind this voice, for example, “It is understandable why you have a fear of going mad—this is all tied to your early experience of witnessing your mum's difficulties with madness and how scary this was for you.” A combination of chair‐work, role‐play, imagery, and letter writing techniques (also see Matos and Steindl [2020] and Cheli [2021]) were used to practice compassionate listening and dialogue between the client and her voices. In one imagery role‐play exercise, the client experienced a visual hallucination of her mum wearing a brown coat at the same moment that her voice on the left said “you're going to go mad.” This co‐occurrence cemented for the client the association between her voice and the childhood fears around her mum's illness.…”

A case study on a severe paranoid personality disorder client treated with metacognitive interpersonal therapy

“…Second, our study suggests the feasibility of an intervention for severe forms of paranoid and antisocial pathologies where we used experiential techniques such as guided imagery, rescripting and chairwork, together with mindfulness techniques since the very first sessions (see Matos & Steindl, 2020 for a similar combination of interventions from another therapy tradition). This combination of techniques, together with a tactful regulation of the therapeutic alliance (Safran & Muran, 2000) may have been key in promoting the patient's awareness of being driven by schemas and in developing new and healthier ideas about himself and others.…”

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

“…The course of treatment entailed broadening the areas for self‐evaluation, conducting behavioral experiments to test out beliefs and predictions, and addressing personal standards and self‐criticism. As in the case of Matos and Steindl (2020), the end goal was not to eliminate perfectionism, given its functional side, but to provide an understanding of the processes that maintain perfectionism and which are also maintained by perfectionism so as to interrupt this loop and increase the quality of life. The case study's end goal exemplifies what Overholser and Dimaggio (2020) called the wisdom of “good enough” where high standards can be adaptive up to a point and, therefore, eradicating them is not a target, but in a moderate approach is recommended most of the times.…”

“…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.…”