THE COGNITIVE AND TREATMENT ASPECTS OF PERFECTIONISM: INTRODUCTION TO THE SPECIAL ISSUE

Transcription

1 Journal of Rational-Emotive & Cognitive-Behavior Therapy, Vol. 22, No. 4, Winter 2004 (Ó 2004) THE COGNITIVE AND TREATMENT ASPECTS OF PERFECTIONISM: INTRODUCTION TO THE SPECIAL ISSUE Gordon L. Flett York University Paul L. Hewitt University of British Columbia To our knowledge, this special issue on the cognitive and treatment aspects of perfectionism is the first special issue on perfectionism to ever appear in a journal. It is most fitting that this special issue appears in the Journal of Rational-Emotive and Cognitive-Behavior Therapy given the extensive contributions of Albert Ellis to our understanding of dysfunctional perfectionism (see Ellis, 1957, 1962, 2002). Ellis identified irrational beliefs involving perfectionism (i.e., I must be perfect in order to be worthwhile) as playing a significant role in a wide variety of personal adjustment problems, including anxiety and depression, as well as in interpersonal problems (see Ellis, 2002). Over the years, research and theory on REBT has emphasized the inextricable link between perfectionism and a number of core themes, including the irrational fear of failure, the role of conditional acceptance of the self and others in psychological problems, the pitfalls of thinking that a person must achieve at an exceptionally high level in order to be worthy of affection and respect, and, in general, the irrational pursuit of extreme, unrealistic goals. A related REBT theme derived initially from Horney (1950) is Address correspondence to Gordon L. Flett, Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada; gflett@yorku.ca. 233 Ó 2004 Springer Science+Business Media, Inc.

2 234 Journal of Rational-Emotive & Cognitive-Behavior Therapy the tyranny of the shoulds. These shoulds can be directed both toward the self and toward other people. Measures such as Jones s (1969) Irrational Beliefs Test have included subscales that reflect themes involving perfectionism, and empirical investigations have confirmed an association between core irrational beliefs and trait dimensions of perfectionism (see Flett, Hewitt, Blankstein, & Koledin, 1991). REBT and its proponents have promoted an uncompromised view of perfectionism as maladaptive and debilitating, and this stands in stark contrast with the views of some researchers who suggest that certain aspects of perfectionism have an adaptive component. However, seminal theorists such as Ellis (2002) remind us that when perfectionism is seen as an absolute must (i.e., I have to be perfect) versus a want or a desire (i.e., I would like to be perfect), then perfectionism compels the individual to strive for an unrealistic level of attainment that is inherently self-defeating in a variety of ways. The papers in this special issue touch on past themes identified in the contemporary literature, but the authors of these papers also raise some new issues. The basic premise that underscores these papers is that the irrational desire to be perfect involves a complex interplay of cognitive, emotional, interpersonal, and behavioral factors, and people debilitated by extreme perfectionism need an equally complex treatment approach. We will now provide an overview of the various papers, and outline how the papers in this special issue represent unique contributions to the perfectionism literature. The first paper by DiBartolo, Frost, Chang, LaSota, and Grills (2004) involves a fine-grained analysis of the content of the personal standards subscale of the Multidimensional Perfectionism Scale created by Frost, Marten, Lahart, and Rosenblate (1990). DiBartolo et al. (2004) describe a revised five-item factor of pure personal standards that is uncontaminated with item content involving judgments of conditional selfworth, and they compare this factor with two other factors that do involve aspects of contingent self-worth. DiBartolo et al. demonstrate that their purer measure of standards is unrelated to life stress and maladjustment, while the two measures of conditional self-worth are associated significantly with stress and maladjustment. These data support DiBartolo et al. s contention that maladjustment is not associated with striving for high personal standards per se, but rather, it stems from the tendency to link perfectionistic striving with a related tendency to base self-worth on the attainment of these standards. Although it is tempting to conclude on the basis of these data that striving

3 Gordon L. Flett and Paul L. Hewitt 235 for perfectionistic standards, in and of itself, is relatively benign and can be quite positive, other results reported by DiBartolo et al. (2004) indicate that a high level of pure personal standards is also correlated with elevated scores on both the activity-based and success-based conditional self-worth measures. That is, perfectionists characterized by pure personal standards (as assessed by a decontaminated measure) also tend to have a conditional sense of self-worth, and these perfectionists ought to be vulnerable to ego-involving performance feedback and outcomes which suggest that they are not meet standards. The next paper by Lundh (2004) is a conceptual analysis that further underscores the link between the perfectionism construct and contingent self-worth. Lundh (2004) focuses on perfectionism and acceptance of self and others, and, in so doing, builds on past findings suggesting that low self-acceptance is a factor that is associated with elevated scores on the Burns Perfectionism Scale (see Pirot, 1986) and on indices of self-oriented, other-oriented, and socially prescribed perfectionism (see Flett, Russo, & Hewitt, 1994). The current paper by Lundh (2004) extends past analyses of perfectionism and acceptance of the self and others in two major respects. First, Lundh (2004) discusses perfectionism and acceptance within the context of a multidimensional view of perfectionism (i.e., What does it mean to have acceptance with respect to self-oriented, other-oriented, and socially prescribed perfectionism?). Lundh also provides an engaging discussion of the role of acceptance in the treatment of perfectionism, and this includes a discussion of the pitfalls of striving for perfect acceptance in treatment. The third paper by Blankstein and Winkworth (2004) follows from recent attempts to link perfectionism with individual differences in attributional style. Blankstein and Winkworth (2004) report the results of a novel study that shows the link between perfectionism and cognitive attributions to specific internal and external factors. Several new findings are described in the Blankstein and Winkworth (2004) paper. For instance, Blankstein and Winkworth show that socially prescribed perfectionism is associated with a tendency to make complex attributions to a host of both external factors (e.g., family conflicts) and internal factors (e.g., insufficient effort). In addition, consistent with the themes of this special issue, Blankstein and Winkworth (2004) illustrate the link between perfectionism and maladaptive cognitions as an attributional focus. Specifically, both self-oriented and socially prescribed perfectionism are associated with a tendency to blame an academic performance problem on unrealistically high personal standards and associated cognitions. Also, their paper represents one of the

4 236 Journal of Rational-Emotive & Cognitive-Behavior Therapy few studies that systematically examine the role of gender differences in perfectionism. The fourth paper by Besser, Flett, and Hewitt (2004) summarizes the results of a unique experiment that examines perfectionists responses to failure versus success. The impetus for this study was our interest in exploring how self-oriented perfectionists react when they experience failure feedback after performing a challenging task. Although several studies have shown that self-oriented perfectionists may be at risk for depression if they experience life stress (Flett, Hewitt, Blankstein, & Mosher, 1995; Hewitt & Flett, 1993; Hewitt, Flett, & Ediger, 1996), these findings have not always been replicated. Moreover, researchers have sometimes found that self-oriented perfectionism and related measures of high personal standards are either associated with positive adjustment measures, or they are unrelated to measures of adjustment, and, as a result, they have characterized self-oriented perfectionism as adaptive (see Flett & Hewitt, 2002, for a review). However, in contrast to recent statements about the possible adaptiveness of selforiented perfectionism, the Besser et al. (2004) paper shows how self-oriented perfectionists are debilitated, both in terms of cognition and affect, when they receive negative feedback about their performance on a challenging task. The analyses confirm that self-oriented perfectionists engage in excessive cognitive rumination, place irrational importance on performance outcomes, experience various forms of negative affect, and make negative social comparisons. Besser et al. (2004) also report that self-oriented perfectionists were particularly disappointed with their performance when they received negative feedback. This fits with some other findings highlighting a link between self-oriented perfectionism and performance dissatisfaction (Enns, Cox, Sareen, & Freeman, 2001; Mor, Day, Flett, & Hewitt, 1995), and questions that have been raised about so-called adaptive forms of perfectionism, which have also been referred to as positive perfectionism (see Flett & Hewitt, in press). The current results also accord with empirical evidence indicating that a construct assessing adaptive perfectionism can actually be linked with higher levels of depression, anxiety, and stress (see Bieling, Israeli, & Antony, 2004; Dunkley, Zuroff, & Blankstein, 2003; Enns & Cox, 1999). In many respects, the negative characteristics of self-oriented perfectionism described in the Besser et al. (2004) paper are very much in keeping with Hamachek s (1978) insightful description of neurotic perfectionists. The essence of neurotic perfectionists is their self-dissatisfaction.

5 Gordon L. Flett and Paul L. Hewitt 237 The final paper by McCown and Carlson (2004) is a unique investigation of perfectionism in cocaine abusing clients with co-morbid personality disorders. This is a timely study given recent evidence indicating that perfectionism predicts comorbidity of disorders (Bieling, Summerfeldt, Israeli, & Antony, 2004). McCown and Carlson (2004) report that levels of socially prescribed perfectionism are elevated in cocaine abusing clients with narcissistic personality disorder (NPD). They also report that cocaine abusing clients with NPD or antisocial personality disorder have substantially elevated levels of other-oriented perfectionism, relative to clients with mood disorder, and relative to existing clinical norms for the Multidimensional Perfectionism Scale (see Hewitt, Flett, Turnbull-Donovan, & Mikail, 1991). Their most striking finding is that other-oriented perfectionism in cocaine abusing clients with NPD predicts earlier self-termination from treatment. Although there is growing evidence for the negative treatment implications of perfectionism (see Blatt & Zuroff, 2002), The McCown and Carlson (2004) study is the first investigation to examine perfectionism and treatment response from a multidimensional perspective and it is the first study to demonstrate empirically what most therapists have probably known for years that is, patients who have exceedingly high expectations are less likely to experience positive treatment outcomes. So, how should treatment proceed with such perfectionists? Here, Ellis (2002) has provided some valuable insights as part of his case description of John, the perfectionist who was so demanding of himself and others that he was going to be divorced not only by his wife, but also by his business partners! Ellis (2002) observed that it was actually easier to address John s other-oriented perfectionism rather than selforiented perfectionism. Ellis (2002) recounted that: I had a rough time, at first, showing him the folly of his own performance-oriented perfectionism, because he was willing to strive mightily to achieve it and suffer occasional panic attacks when he didn t. It was easier to show him that his demands on others just wouldn t work. He had little control over others, and they were going to continue to be just as abominably unperfectionistic -- not to mention downright sloppy -- as they chose. They shouldn t be that way but they are (Ellis, 2002, p. 225). Ellis concluded that several sessions of REBT were successful in getting John to prefer perfect behaviors from others rather than demanding perfect behaviors. Thus, in this instance, an absolute demand was transformed into a desire.

6 238 Journal of Rational-Emotive & Cognitive-Behavior Therapy We are aware of numerous case examples of the difficulties associated with treating extreme other-oriented perfectionists, and these difficulties are compounded if high levels of other-oriented perfectionism co-exist with high levels of socially prescribed perfectionism within the same individual. Descriptions of other-oriented perfectionists emphasize that these individuals tend to be high in a desire for control (Flett et al., 1995), and they have narcissistic features, a tendency to blame others (Hewitt & Flett, 1991; 2004), and a hostile interpersonal style (see Habke & Flynn, 2002). It remains to be determined whether otheroriented perfectionists should be confronted and challenged by their therapists, or, alternatively, it is better to be less direct and confrontational with these individuals. We will conclude our introduction by thanking Windy Dryden for the opportunity to work on this special issue. We hope that readers of this special issue find this series of papers to be both timely and informative. Contemporary research and theory continue to underscore the fact that perfectionism is an exceedingly complex construct and high levels of perfectionism can be exceptionally debilitating for vulnerable perfectionists. REFERENCES Besser, A., Flett, G. L., & Hewitt, P. L. (2004). Perfectionism, cognition, and affect in response to performance failure versus success. Journal of Rational-Emotive and Cognitive-Behavior Therapy. Bieling, P. J., Israeli, A. L., & Antony, M. (2004). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36, Bieling, P. J., Summerfeldt, L. J., Israeli, A. L., & Antony, M. M. (2004). Perfectionism as an explanatory construct in comorbidity of Axis I disorders. Journal of Psychopathology and Behavioral Assessment, 26, Blankstein, K. R., & Winkworth, G. R. (2004). Dimensions of perfectionism and levels of attributions for grades: Relations with dysphoria and academic performance. Journal of Rational-Emotive and Cognitive Behavior Therapy. 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 ). Washington, DC: American Psychological Association.

7 Gordon L. Flett and Paul L. Hewitt 239 DiBartolo, P. M., Frost, R. O., Chang, P., LaSota, M., & Grills, A. E. (2004). Shedding light on the relationship between personal standards and psychopathology: The case for contingent self-worth. Journal of Rational- Emotive and Cognitive-Behavior Therapy. Dunkley, D. M., Zuroff, D. C., & Blankstein, K. R. (2003). Self-critical perfectionism and daily affect: Dispositional and situational influences on stress and coping. Journal of Personality and Social Psychology, 84, Ellis, A. E. (1957). How to live with a neurotic: At work and at home. New York: Crown. Ellis, A. E. (1962). Reason and emotion in psychotherapy. Secaucas, NJ: The Citadel Press. Ellis, A. (2002). The role of irrational beliefs in perfectionism. In G. L. Flett, & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp ). Washington, DC: American Psychological Association. Enns, M. W., & Cox, B. J. (1999). Perfectionism and depressive symptom severity in major depressive disorder. Behaviour Research and Therapy. 37, Enns, M. W., Cox, B. J., Sareen, J., & Freeman, P. (2001). Adaptive and maladaptive perfectionism in medical students: A longitudinal investigation. Medical Education, 35, Flett, G. L., & Hewitt, P. L. (2002). Perfectionism and maladjustment:an overview of theoretical, definitional, and treatment issues. In G. L. Flett, & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp ). Washington, DC: American Psychological Association. Flett, G. L., & Hewitt, P. L. (in press). Positive versus negative perfectionism in psychopathology: A comment on Slade and Owens dual process model. Behavior Modification. Flett, G. L., Hewitt, P. L., Blankstein, K. R., & Koledin, S. (1991). Dimensions of perfectionism and irrational thinking. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 9, Flett, G. L., Hewitt, P. L., Blankstein, K. R., & Mosher, S. W. (1995). Perfectionism, life events, and depressive symptoms: A test of a diathesisstress model. Current Psychology, 14, Flett, G. L., Russo, F. A., & Hewitt, P. L. (1994). Dimensions of perfectionism and constructive thinking as a coping response. Journal of Rational- Emotive and Cognitive-Behavior Therapy, 12, Frost, R. O., Marten, P. A., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, Habke, A. M., & Flynn, C. A. (2002). Interpersonal aspects of trait perfectionism. In G. L. Flett, & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp ). Washington, DC: American Psychological Association. Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. Psychology, 15,

8 240 Journal of Rational-Emotive & Cognitive-Behavior Therapy Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, Hewitt, P. L., & Flett, G. L. (1993). Dimensions of perfectionism, daily stress, and depression: A test of the specific vulnerability hypothesis. Journal of Abnormal Psychology, 102, Hewitt, P. L., & Flett, G. L. (2004). Multidimensional Perfectionism Scale: Technical manual. Toronto: Multi-Health Systems Inc.. Hewitt, P. L., Flett, G. L., & Ediger, E. (1996). Perfectionism and depression: Longitudinal assessment of a specific vulnerability hypothesis. Journal of Abnormal Psychology, 105, Hewitt, P. L., Flett, G. L., Turnbull-Donovan, W., & Mikail, S. F. (1991). The Multidimensional Perfectionism Scale: Reliability, validity, and psychometric properties in psychiatric samples. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3, Horney, K. (1950). Neurosis and human growth. New York: Norton. Jones, R. G. (1969). A factorial measure of Ellis irrational belief system, with personality and maladjustment correlates. Dissertation Abstracts International. 29, 4379 B (University Microfilms No ). Lundh, L-G. (2004). Perfectionism and acceptance. Journal of Rational- Emotive and Cognitive Behavior Therapy. McCown, W. G., & Carlson, G. (2004). Narcissism, perfectionism, and selftermination from treatment in outpatient cocaine users. Journal of Rational-Emotive and Cognitive Behavior Therapy. Mor, S., Day, H. I., Flett, G. L., & Hewitt, P. L. (1995). Perfectionism, control, and components of performance anxiety in professional performers. Cognitive Therapy and Research. 19, Pirot, M. (1986). The pathological thought and dynamics of the perfectionist. Individual Psychology: The Journal of Adlerian Theory, Research, and Practice. 42,