Barbara Morrell, Ph.D. Brigham Young University Presented at the AMCAP Spring Convention April 3, 2008

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Barbara Morrell, Ph.D.

Brigham Young University


Presented at the AMCAP Spring Convention

April 3, 2008


Perfectionism is not a quest for
the best. It is a pursuit of the
worst in ourselves, the part that
tells us that nothing we do will
ever be good enough


that we
should try again
.”







Julia Cameron



Heresy Seven: There are those who believe we must
be perfect to gain salvation.



This is . . .a doctrinal misunderstanding. . .Faithful
members of the Church will be saved, even though
they are far from perfect in this life. . .[Joseph
Smith] taught that there are many things to be
done, even beyond the grave, in working out our
salvation.”


Bruce R.
McConkie

“The Seven Deadly Heresies,”
(1980)

“Perfectionists are apt to be especially familiar
with the self
-
conscious emotions [i.e. shame,
guilt, embarrassment, pride] because they
focus so much energy on self
-
evaluation.
Perfectionists do not just set high, often rigid,
standards for themselves in a particular
domain;
they are oriented toward the process
of evaluation
. Life is a series of quizzes, tests,
and final exams, and their name is always at
the top of the report card.”









(Tangney, 2002, p. 199)


How do clients
learn
Perfectionism?

Sources of Perfectionism


American/Asian/other Cultures


Competition Mentality


Worth based on achievements, looks, money, success


Mormon Culture


Distortion of Doctrine of Eternal Perfection


Influence of American culture


Negative feedback in childhood


Human Nature/Natural Temperament


Anxiety: Biological Predisposition


Attachment Issues/Abuse/Neglect





Doctrine of Eternal Perfection vs.
Cultural Perfectionism


Language: Matt 5:48 “Be ye therefore Perfect” vs. “Be ye
therefore complete and fully developed (in the
eternities).”


Two sets of undifferentiated values: Eternal and Material


Equating behavior with the essence of the self:

bad behavior = bad person


All things become moral: grades, looks, income, talents,
etc.


The LDS Therapist’s Dilemma:

How do we facilitate clients in
modifying perfectionism as a
therapist
,
not

as a teacher,
leader, or church member?

Potential Pitfalls for LDS Therapists
working with LDS Clients


Assuming we understand a client’s worldview and values
because they are LDS (or another religion)


Violating ethics by entering a client’s spiritual/religious
world without permission


Alienating a client who is struggling with their beliefs
and/or affiliation


Feeling responsible for clients to make good choices and
becoming another voice of authority


Imposing Mormon cultural ideals or “
shoulds
” on clients
because of our own unexamined cultural influences

Helping Clients
Teach Themselves
Correct Doctrine: Guidelines


Wait for clients to raise Spiritual/Religious concerns


Ask about clients’ beliefs and worldview and validate
their individuality and agency


Don’t make assumptions about what clients want
spiritually and religiously


Clarify our role as a therapist, not a doctrinal authority


Don’t assume we have the answers for spiritual dilemmas


Follow the client’s lead


Ask permission to use spiritual interventions, even when
clients raises spiritual issues



Understanding the Impact of
Perfectionism on Clients


Assess client’s view of how self
-
critical or
perfectionistic

tendencies affect them: level of self
-
awareness



Assess severity of impact of client’s perfectionism on
psychological well
-
being and functioning.



Seek to understand the origins of client’s perfectionism to
help with treatment planning.

Influences on Perfectionism:
Continuum of Severity

Competitive
Cultural
Environment

(in and out of
church settings)



Peer Rejection


Perceived Failure



Family Examples,


Expectations


and/or

Negative
Feedback


Attachment/

Trauma Issues

(profound
underlying
negative

sense
-
of
-
self)

Cultural Perfectionism:

Chicken or Egg?

Does American/Mormon culture breed
Perfectionism or do individuals who
feel a sense of inherent “badness” or
“worthlessness” project their
feelings about themselves onto the
doctrine?

Shame vs. Guilt


“People experiencing guilt often are motivated to confess,
apologize, or atone. In contrast, when people feel shame,
our key concern is with our self, as a person.
Feelings of
shame involve a painful negative scrutiny of the entire
self
-
a feeling that “I am an unworthy, incompetent, or
bad person.”
They feel worthless and powerless, and they
feel exposed. As in guilt, feelings of shame can arise from
a specific behavior or transgression, but the . . .“bad
behavior” is taken not simply as a local transgression,
requiring reparation or apology; rather, the offending or
objectionable behavior is seen as a reflection, more
generally, of a defective, objectionable self.”







(Tangney, 2002, p. 201)

Attachment and the Self


“Attachment bonding is critical to development of the right brain
systems involved in processing emotion, modulation of stress, self
-
regulation, and the
early origins of the bodily
-
based implicit self.








(
Schore

, 2003)



Through constant interactions from birth,
the caregiver is a mirror
for child to develop his/her sense of self
.







(
Kohut

in
Cashdan
, 1988)



Internalized negative and positive interactions become the basis for
sense of self: parental negative voice becomes internalized






(
Melnick
, 1995)

Mother
-
Infant
Communication

and Attachment

Communication happens Right Brain to Right Brain



80% of Right and Left
-
handed mothers cradle infant in left
arm

easier access to left ear and face (right brain)





“During eye
-
to
-
eye transactions the infant’s maturing right
hemisphere is ‘psycho biologically attuned’ to the output of
the mother’s right hemisphere.”








(
Schore
, 1995)









Left side of face shows emotions: Van Gogh Self
-
Portrait


Focus of Therapy for

Attachment Issues


Right Brain (non
-
verbal) Relational connection


Corrective Emotional experience


Neuroplasticity
:


Brain can rewire healthier attachment patterns


Sense of self can develop more positively






(
Schore
, 2005)

Skills Training:


DBT, ACT: Emotional Regulation, Distress Tolerance,

Mindfulness, etc.

Implications for Therapy



For severely
perfectionistic

clients a frontal attack on
their perfectionism may feel like attack on the self.



Positive feedback about their worth may generate
confusion and emotional pain instead of relief



Clients may have intense fear of change



The therapeutic relationship may be difficult to build and
maintain (
Blatt
, et al 2002)


General Treatment Considerations

for Perfectionism


Explore, understand, empathize with feelings of worthlessness
before challenging them: Challenge is inherently non
-
validating



Process fears of change: “who will I be?”; “loss of motivation &
achievement;” “what if I’m wrong?” “what will others think?”



Shame vs. Guilt or Remorse: Shame indicates deep
-
seated negative
sense of self



Axis I Disorders: Anxiety and Depression must often be addressed
before perfectionism can be tackled



Questions and Feedback to Promote

Self
-
Exploration & Understanding


You seem really hard on yourself. How do you feel about that?

How
does it affect you?


How does it help/hurt you to have such high expectations?


How does being hard on yourself affect your anxiety/depression?


Is that something you want to work on changing?


Where did you learn to be so self
-
critical? What are you earliest
memories of feeling inadequate?


What are your fears of changing? What would you lose? How
would things be different? What would you like about that?


I’m not sure I understand your guilt for getting B’s. Do you believe
grades can make you more or less righteous?


What do you believe makes a person important or worthwhile?


It sounds like you believe in unconditional worth for others, but not
for yourself. How fair is that? What gets in the way of believing in
your worth?




Questions & Feedback cont.


So you believe that something is wrong with you because you can’t do
it all? That sounds very painful. What is it like for you?


How possible is for anyone to do it all perfectly? Why not?


(If they raise LDS doctrine of Perfection) Does LDS doctrine say God
expects you to be perfect right now? Is there anything you know that
tells you that might not be true? How do you think God sees your
weaknesses? It sounds like you judge yourself more harshly than God
does.


You really hate to be human don’t you? Me, too. What is painful about
making mistakes for you?


How would you like to see yourself? How would you like to view your
mistakes and weaknesses? It’s really hard to change things you’ve
believed for many years. It can be like fighting a tidal wave.


It seems like you feel caught between the eternal perspective and the
worldly perspective of your worth. What would you like to base your
life on? How would things be different if you did?


Changing Beliefs (Not just Thoughts)


Focus on Negative/
Perfectionistic

beliefs as
“learned”
and the process
of
“unlearning”
them
:


Normal to reach adulthood with irrational beliefs, but don’t have to
keep believing them.



Teaching self “correct doctrine”



Differentiate “behavior” and “achievement” from “personhood”:


Instead of “better” and “worse” think “better off” and “worse off”
(positive and negative consequences)



Deepening New Beliefs

From Head to Heart:


Use of analogies to understand
process

of change and growth:
Alma’s seed, learning to play the piano, etc.


Internalizing in a way that works for individual clients: Reading,
talking, thinking, writing, praying, feedback from others.












Use of Scriptures & Religious Quotes


Pros

of using scriptures:


May be very appropriate if client is comfortable with it(may help
to ask if they are interested in seeing a scripture that relates to
the point of doctrine they are wrestling with).


Can be used in a way to help clients “teach themselves”


“How is this different from how you have been seeing this issue?”


Cons

of using scriptures:


Can shut down process of finding own answers if seen as “the
answer” or “solution”, or that the therapist is a church authority.


Might seem too simplistic or prescriptive.


Can be very alienating to some clients who are struggling.


Using a Developmental Perspective


Help clients understand how a negative sense of self develops


Children think in black and white
--

believe the negative feedback they receive,
so view self as bad


Children tend to blame themselves for bad things and think it is their fault



Encourage clients to view selves in the process of normal Development:


Clarifying Values (
Chickering
): Highlighting contradictions between conflicting
sets of values and beliefs (Mormon Culture vs. Doctrine vs. Materialism) and
making conscious choices


Process of Separation/Individuation/Identity Development (
Chickering
)


From Dualistic (Good/Bad) view of self and others to more complex view
(Perry)


Young Adulthood as the time to sort through beliefs learned in childhood and
to teach oneself “correct doctrine” or see what is true with adult eyes.


A perceived weakness is not a flaw, but something we haven’t yet learned to
do.

Treating Attachment &

Trauma
-
Related Perfectionism


Emotional/Trauma processing: Negative,
perfectionistic

beliefs about self
are often embedded in memories and/or family dynamics.



Work on understanding they survived as best they could and that
adult/peer/perpetrator treatment of them wasn’t about them.



Self
-
care: Learn from experience that attending to one’s own needs is
important.



Re
-
parenting Oneself: How would an unconditionally loving parent talk to
you about this weakness or mistake?



Attending to outside Relationships: People learn self
-
love in supportive
relationships: Friends, Mentors, Bishops, Spouses & dating partners, etc.









Skills, Awareness, Interventions


Acceptance Commitment Therapy (ACT): Focus on
Mindfulness & Self
-
awareness, Acceptance & Tolerance of
Distress & Pain



DBT Skills Training: Mindfulness, Emotional Regulation,
Distress Tolerance, Interpersonal Effectiveness



Positive Psychology Interventions



Bibliotherapy



Relaxation and Imagery for Ego
-
strengthening:
http://ccc.byu.edu/counseling/skills.php


Case Examples


Melissa: “Then I would have a choice.”



Mark: Question: “Do you believe the Lord grades on the
curve?” His answer: “I want to be the first one into the
Celestial Kingdom.”



Sam: “I’m going to cure myself of Perfectionism and
Masturbation by tomorrow.”



Melanie: “I’m really starting to get that it wasn’t about me.”


Perfectionizm

Bibliotherapy

Burns, David, (1980).
Feeling Good: The New Mood Therapy
, Signet: New York.


Dew, Sheri (2004).
No One Can Take Your Place
, Deseret Book: Salt Lake City


Holland, Jeffrey R. “The Other Prodigal.”
Ensign
, May, 2002, 62.
http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=f318118dd536c010VgnVCM1000
004d82620aRCRD&locale=0&sourceId=13d68d00422fe010VgnVCM100000176f620
a____&hideNav=1


McConkie
, Bruce R. (1980). “The Seven Deadly Heresies,”
http://speeches.byu.edu/reader/reader.php?id=6770


Nielsen, “Perfection Pending.”
Ensign
, November 1995
http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=2354fccf2b7db010VgnVCM1000
004d82620aRCRD&locale=0&sourceId=453c6e9ce9b1c010VgnVCM1000004d82620
a____&hideNav=1


Okazaki, Chieko, (2002).
Being Enough
,
Bookcraft
: Salt Lake City.



Bibliotherapy

cont.

Robinson, Stephen, (1992).
Believing Christ
, Deseret Book: Salt Lake
City.


Samuelson, C. O. “What Does it Mean to be Perfect”
New Era
,
January, 2006, 10
-
13.
http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=024644f8f206c01
0VgnVCM1000004d82620aRCRD&locale=0&sourceId=ca81092480e
6c010VgnVCM1000004d82620a____&hideNav=1

Seligman, Martin, (1991).
Learned Optimism,
Pocket Books, New York.


Seligman Positive Psychology Website:
http://www.authentichappiness.sas.upenn.edu/Default.aspx


Ulrich, Wendy (2007)
Forgiving Ourselves: Getting Back Up When We
Let Ourselves Down
, Desert Book: Salt Lake City


“Brothers and sisters, I testify that no one of us
is less treasured or cherished of God than
another. I testify that He loves each of us
——
insecurities, anxieties, self
-
image, and all. He
doesn’t measure our talents or our looks; He
doesn’t measure our professions or our
possessions. He cheers on
every

runner, calling
out that the race is against sin,
not

against
each other. “




Jeffrey R. Holland “The Other Prodigal”





Ensign, May, 2002


References

Blatt
, S. J. &
Zuroff
, D. C. (2002). Perfectionism in the therapeutic process. In G.L.
Flett

&
P.L. Hewitt (Eds.), Perfectionism: Theory, Research, and Treatment (pp.393
-
406).
Washington, DC: APA


Bowlby
, J. (1988).
A secure base: Parent
-
Child attachment and healthy human development.

New York: Basic Books, Inc.


Cashdon
, S. (1988
). Object relations therapy
. New York: W.W. Norton & Company:


Melnick
, S. (2005). “Trauma and Attachment” Presentation at the Harvard Medical School
Attachment and Related Disorders conference, Boston, May 7, 2005.


Shore, A. (2003).
Affect
disregulation

and disorders of the self
. New York: Norton.


Shore, A. (2005). “Recent Advances in the Neurobiology of Attachment: Implications for
Interventions and Prevention.” Presentation at the Harvard Medical School Attachment
and Related Disorders conference, Boston, May 6, 2005.


Tangney, J.P. (2002). “Perfectionism and the Self
-
Conscious Emotions: Shame, Guilt,


Embarrassment, and Pride.” In G.L.
Flett

& P.L. Hewitt (Eds.), Perfectionism: Theory,
Research, and Treatment (pp.393
-
406). Washington, DC: APA


Contact Information: barbara_morrell@byu.edu