Perfectionism Therapy Using TEAM-CBT
A Treatment Overview
If you’ve tried therapy before, or even if you’ve just seen what it’s like on TV, and you’re skeptical it can make a real difference in your symptoms, you’re not alone. About half of my clients have worked with counselors in the past. They’ve appreciated talking to a good listener about what’s bothering them but never experienced dramatic transformations.
Treating Perfectionism Is Challenging
My clients already know they don’t fully agree with themselves. They’ve been told a zillion times to just “let it go! Don’t be so hard on yourself!” They know the next achievement isn’t going to finally feel like enough.
If knowing that something could be different was enough, they would have done it immediately. They do tend to be achievers, after all.
Perfectionism Creates Deep Suffering. It Also Promises Security and Motivation.
“I know you think I should just slack off and be okay with it, but…” My client thought I wanted her to transform and become okay with mediocrity. No perfectionist would find it easy to flip off like a switch - or would even want to. High standards have helped you in so many ways! For lots of my clients, high standards have been the ticket out of some terrible childhood situations.
Thankfully, there are ways to hold onto the excellence, people, and goals that matter to you without accepting intense self-criticism and panic as the cost of admission.
Perfectionism and Depression: High Standards Don’t Always Lead to Achievement
If your perfectionism is preventing you from achieving your goals and looks a bit more like depression, it’s still helping in meaningful ways.
Depression-based perfectionism tends to be my most frequent experience, and it keeps me from taking risks so I can avoid disappointment and public humiliation.
That has downsides, but imagine sauntering into the most optimistic view of your current circumstances without the tiniest bit of self-awareness or concern about the outcome. I love the image of the saunter, but it’s probably a good idea to bring a pinch of caution and a teaspoon of skepticism.
Most Therapy is Helpful but not Transformative
My husband laughs at me when we watch TV because any scene involving a therapist is likely to have me muttering under my breath. “That’s not how you… wait, what is he doing?” or “No. No, no, no, no. That’s a terrible plan.”
Movies and TV shows want to entertain, not teach us about therapy or show a healthy therapeutic relationship. Usually, the therapist exists so that we get to hear the main character talk about their emotions or motivations. Unfortunately, on-screen therapy is the only view most of us ever get of what goes on in therapy. Even as a therapist, without sitting in on thousands of sessions, I can’t know what most therapy is like.
I do know that my official training didn’t produce an effective therapist. The requirements to graduate with a degree in counseling and even to become a licensed therapist are no small thing. The process is demanding, but it’s a matter of jumping over hurdles not demonstrating an ability to provide effective treatment.
Our Expectations For Effective Therapy Are So Low
Transformation is Possible?
You’ve gotten advice before about how to feel better. You know it’s usually unsatisfying. Sure, I could go for a walk, and as soon as I come back here and look at my computer again, I’ll be in the same place I started. Advice is well-meaning, but if that’s all we get out of therapy, not much is going to change in the long run.
There are two aspects of TV-style therapy—i.e. showing up and telling all the stories of things that happened to you that week—that can have a genuinely transformative effect:
First, if you are honest with your therapist, you face your fear of revealing the things you like least about yourself and discover that it’s not so bad.
Second, depending on how open you are about what’s bothering you, you might cry and feel deeply sad, angry, or discouraged. There’s a benefit in simply acknowledging and experiencing those emotions. In most settings, we push those to the side and avoid them or feel ashamed of them.
The great news is that a more noticeable transformation than that is possible. Not only that, but you can learn how to apply it to new situations for the rest of your life.
What Makes Perfectionism Treatment Transformative?
Where does anxiety come from? Or depression?
When we’re feeling sick physically, we choose treatments based on the cause of the symptoms. Knowing a virus has caused an illness helps us decide what to do about it. Similarly, it’s helpful to know the root causes of our emotional suffering.
And just as earlier generations probably didn’t think that viruses sounded terribly realistic, it doesn’t seem intuitive that our thoughts create our feelings. At the same time, it’s very likely that you’ve noticed other people jumping to conclusions you disagree with. You see your child get frustrated and give up when you know they’re 2 minutes away from solving their problem. Or your coworker is convinced that your boss is showing favoritism when you know there’s more to the story than the picture they’re seeing.
We all have some warps in our understanding of the world. It’s easiest to notice these when they’re other people’s assumptions, misconceptions, projections, or misinterpretations. They can be about anything.
Those warps are usually at the root of our distress. To feel peaceful and motivated, we need to figure out which specific ones we have and update our model of things.
Effective Therapy for Perfectionism: A Case Story
Steve is a client I worked with, whose name (and some details) I’ve changed to protect his privacy and confidentiality. He had a technical job that demanded high precision and attention to detail. He was married and had two kids in elementary school. He loved his wife but found her a bit harsh and was hesitant to be open and vulnerable with her, knowing she might lash out. They were woven into their community, but neighborhood life stressed Steve out. He worried he would forget something or fail to fulfill an obligation. He also worried that friends or family would notice his anxiety and judge or reject him because of it.
Steve came to therapy because all his first impulses (to quit his job, leave his relationship, or cut ties with neighbors and friends) involved worse consequences than the status quo. He felt stuck.
Fortunately, those responses weren’t the only avenue available to Steve. A change in external circumstances can be a huge help. They’re much harder to come by, though, and tend to create more problems. We can change the way we feel by changing the way we think.
We are so lucky to be alive right now because humanity has figured out how. At the same time, the foundations of everything I’m saying were discovered ages ago. Great teachers have been trying to share them for hundreds, even thousands, of years. Thankfully, people have discovered even more about how to make those deep truths more learnable.
Effective Therapy for Perfectionism Means Persistent Calm
As difficult as it might be to believe, we can genuinely change the way we think. I don’t mean that we can “buck up, turn that smile upside down, and cultivate a positive attitude, for Christ’s sake,” like you can imagine a high school gym teacher telling you to do.
I’m not talking about forcing a mindset of happiness and hope. I’m talking about changing our thoughts, carefully and on purpose, to be more truthful and more realistic than our automatic ones. When that process works, we don’t need to cycle through lists of cheering-up advice about walks and phone calls. We don’t have to force ourselves to feel better despite ourselves. We just feel better.
Understanding Ourselves
Steve’s first goal was to feel less anxious overall. He could see how fearing the worst by default affected everything else that was bothering him. One of his underlying fears was that people would see him as incompetent and reject him. This fear was not close to the surface at all. It took us some digging to recognize that it existed, let alone what an impact it was having.
Fears of rejection and criticism are nearly universal. Still, we tend to feel ashamed of those fears, thinking, “I shouldn’t care what people think. I should be fine whether somebody else likes me or not.” It sounds incredible to be free of those fears, too, doesn’t it?
But if we got rid of all of our concern and awareness of how other people were seeing us, we might genuinely ostracize ourselves. We’d also cause real problems for the people around us.
If you genuinely were not concerned about how people saw you, you might start “forgetting” your wallet at restaurants with friends. You might curse out your boss (while not intending to quit), play loud music in a library, or punch someone in the face the next time they piss you off.
And we all care what people think of us because people help us survive. Even if we lived waaaaay off the grid, most of us would still be using some materials that other people grew or manufactured. Most of us are much more interconnected than that. We need people to deliver our mail, collect our trash, fix the sink, hire us, hang out with us, listen to our troubles, marry us, bring us casseroles when we’re struggling, or give us a ride to the airport.
People help us survive.
The Core Fears
All of my clients have core fears that connect to physical harm or social rejection. They’re on par. In fact, for many people, even the fear of bodily harm is accompanied by the fear of the implications of that harm for the people they care about. “If I’m injured, I can’t work, and then we don’t have an income.”
So, this idea of being nervous around people or concerned about how we’re coming across is intense.
While this fear makes sense when you put it in terms of survival, it still causes big problems. We agree to things we don’t want to do, keep negative feelings to ourselves, or let them out in tidal waves; we avoid taking risks that could lead to great things (interviews, dates, public speaking).
For Steve, fear that people would reject him included a fear that rejection would mean something true and permanent about him. It would mean the person rejecting him had perceived a profound and objective reality. He might be able to hide it temporarily from other people, but he would never be fundamentally safe and accepted exactly as he was.
Unconscious, Pre-verbal Beliefs
Have you ever had an intense emotional reaction that didn’t match your conscious, analytical take on the situation?
When we’d done our digging and understanding, Steve looked at the statement, “My neighbor is going to see me fail and reject me. Everyone will reject me, including my wife and children, and die homeless and alone.” And he shook his head. It didn’t seem true on a rational, analytical level. He didn’t believe that statement, but he knew it was still operating somehow in his thought processes. It was easiest to notice that if it weren’t there, he wouldn’t feel as stressed as he was.
How could it be that we could identify a belief like this that didn’t ring true to him but still had so much power to bowl him over (circumvent, sabotage?)? If you’ve had moments like this, you know it feels like being stuck in a bare-knuckle boxing match with yourself.
Muscle Memory Is Strong
Even when beliefs don’t seem true to our adult selves, they can still get behind the wheel and drive reactions that undermine the person we’d like to be now. One explanation is that we learn interpersonal skills and rules when we’re little.
We notice subtle cues and responses from our caregivers when we’re young, and one of Steve’s was, “If you mess up, you don’t belong.”
Unless we have profound contradictory experiences, they stay in place and generalize to the rest of our interpersonal lives. Steve had trouble acknowledging ways he hurt his wife because that would mean he’d messed up.
Belief Formation
That’s how our beliefs form: we are constantly collecting data about the world. However, most of it stays in our reasoning analyzing brain unless powerful emotional experiences accompany it.
Using effective therapy, when our emotions are present, and we use powerful tools, our sense memory is engaged, and we’ve developed compassion for our younger selves; we can learn something new (as opposed to trying to force it on ourselves). We disprove the original belief and see things in a new light.
How Does This Work?
Maybe it seems like all therapy is more or less the same. You lie on a couch, you talk about your parents, and then you go home. Maybe you have a vague sense that this would be helpful because a) podcasts and celebrities are always recommending therapy, and b) it is sometimes helpful when you tell a friend about your feelings, and they’re supportive and understanding.
Not all therapy is like that, though.
The types of therapy that tend to produce the profound transformation I’m describing are experiential. They aren’t about talking our way into a new rational understanding of something or analyzing something from an intellectual angle. They aim to bring a powerful emotional experience to life and apply some kind of intervention while it’s present. That is one of the best ways I know to create learning and discovery. And after that kind of experience, it doesn’t take effort and attention to feel differently about that thing - it’s a lasting change.
There are so many kinds of therapy that it’s hard even for fans like me to keep track, but the one I’ve spent the most time learning and practicing is called TEAM-CBT. The steps below describe how I use TEAM-CBT to help perfectionists like Steve find connection and confidence in their relationships.
What Therapy Looks Like at Bit by Bit Counseling
Step 1: Consultation
The first step in working together is finding out if we’re a good fit for each other. I’ll ask you to set up a 20-minute consultation so I can find out what you’re hoping to achieve and whether I think I can help. You’ll also get to know my voice and a little of my style and ask the questions you have about process and logistics.
Step 2: Background
If I can offer what you’re looking for and you want to work together, your next step will be to fill out some paperwork.
Privacy Policy
I usually skim right past this kind of information, but there’s some genuinely important stuff to know about the measures I take to protect your privacy and confidentiality. Much of it applies to other healthcare providers you see, so paying attention to the privacy policy could inform your relationships with them! Reading this paragraph might be how you find out that you have a right to obtain copies of your records or that there are some reasons a provider might release information about you without written consent.
Informed Consent
Therapy, like any intervention, like life itself, is not risk-free! It’s helpful to know what you’re signing up for and think it through before we start.
Diagnostic Assessment
I don’t treat diagnoses and, on some level, don’t see them as particularly meaningful. On another level, this assessment can quickly give me a ton of information that would otherwise take us many sessions to communicate. In our first session, I’ll ask follow-up questions about the assessment and learn more about your life history.
Step 3: Getting to Work
Clarifying Your Goal
When you first come in, you might have a vague idea of what you’d like to be different. After reflecting on it a bit more, talking it through out loud, you will start to be able to picture it - almost to taste it - and imagine how it would feel to wake up without heaviness or dread. What would it mean to you to feel connected to the important people in your life and capable of moving forward feeling calm and hopeful?
Your Emotions, in Granular Detail (Testing and Empathy)
Before that outcome, though, we need to focus on a specific moment when you weren’t feeling that way. Usually, when folks come to sessions, they don’t feel amazing, but it’s also not the worst they’ve felt all week. That creates the risk that we’ll stay on the surface. We might have an open-ended chat about whatever comes to your mind. I’d catch up on your week, you’d think out loud, and we most likely wouldn’t make any changes that might help in the darkest times.
Instead, we’ll focus on just one moment when you were upset. It’s a bit like taking a small sample from a lake to check the water quality, knowing that what’s affecting the water in the sample is also affecting the rest of the lake.
We’ll also get very specific about all the negative emotions you were feeling just then. You might be surprised to see how many there were! We usually sum things up and say, “I was so pissed when that happened!” If we went through the steps, though, we’d probably see that we were also anxious, discouraged, and sad.
Assessing the Costs of Change (Assessment of Change)
Once we’ve identified the emotions, we need to understand them better before changing anything about them. When Steve worked through these steps, he was surprised to see that guilt was a big part of his experience of anxiety. And when we looked closely at the guilt, he could see that he didn’t want it to go away entirely. His guilt was like an indicator light for his connections with other people. Had he done something to hurt someone or piss them off? Did he need to check in? Change something about how he was with them? Without guilt, it wouldn’t feel bad if he’d upset his kids or hurt his wife’s feelings.
But with guilt, he wasn’t open to reconnecting with them. If it seemed like he’d done something that hurt them, he felt defensive and panicky!
We needed to find a Goldilocks level of guilt.
Enough to keep him from being cold and detached about hurting other people, but not so much that he couldn’t feel good about himself, enjoy spending time with them, and hear critical feedback without shutting down.
Step 4: The Transformational Power of Truly Effective Therapy (Methods)
I know of other approaches to therapy that go beyond supportive listening, but I don’t know of any besides TEAM that use so many tools to create profound change. We have dozens of ways to challenge the beliefs causing us so much suffering.
When Steve looked for thoughts that might be creating his guilt, there were a few that seemed to be part of the picture:
“I’m letting everybody down.”
“I should be upbeat and reliable no matter what.”
“I should always know the right thing to do. I should have all the best qualities of masculinity and always know whether people want me to be decisive or flexible.”
Let’s focus on #2: “I should be upbeat and reliable.”
After looking at the costs of change, Steve saw that feeling guilty about this showed that he was self-aware. He saw that his mood affected his family and wanted them to enjoy their time together.
It showed that he felt a sense of agency and accountability for his mood and for keeping his word. He wouldn’t want to lose those entirely because they were important to him. So he’d want to hang onto the kernel of truth in the thought without using it to beat up on himself.
Using Powerful Techniques to Defeat Perfectionism
One method that worked for him was the Double Standard Role Play method. You probably already get the gist, based on the name, but despite its straightforwardness, it’s quite powerful. In particular, we used a modification that sometimes gives this method some extra oomph. While in the role of Steve’s dear friend, who was just like him, I told Steve I’d been struggling and shared my challenges at work and home. At the outset of the role play, I told him that his job was to respond to whatever I said: "You should be upbeat and reliable no matter what.”
In that context, three things hit home for Steve.
Not only would he want to be more encouraging than that with his friend, but
He wanted more genuine friendships where people felt comfortable being honest and didn’t need to pretend to be happy,
Pretending would be the only way that could work because no one is always happy.
We used a lot more methods than just that one, but Steve ultimately found his Goldilocks level of guilt. His anxiety came down, too, and he was able to feel more relaxed and genuine in his relationships.
Ready to get started?
I love showing people how to have agency over where they set their standards for themselves. I love watching people transform their emotional lives, develop deep and genuine compassion for themselves and others, and experience more joy and connection.
If you have questions or want to find out what this would look like for you specifically, check out the Rates & Details page to see if it looks like a good fit, and schedule a free 20-minute consultation.
Cheryl Delaney, MS, LPC
Cheryl Delaney is a Georgia-based therapist specializing in therapy for perfectionism through online counseling. She’s had lots of different forms of anxiety herself, and loves showing other people how to feel more joyful, connected, and capable of meeting their goals. If you’re curious, there’s lots more information about Cheryl and her approach (TEAM-CBT), and you can always schedule a free consultation to ask questions about how therapy might work for you.