ATHABASCA UNIVERSITY TREATING PERFECTIONISM POSITIVELY: A COUNSELLOR S GUIDEBOOK TO INTERVENTION STRATEGIES STEPHANIE WILLSON

Transcription

1 ATHABASCA UNIVERSITY TREATING PERFECTIONISM POSITIVELY: A COUNSELLOR S GUIDEBOOK TO INTERVENTION STRATEGIES BY STEPHANIE WILLSON A Final Project submitted to the Graduate Centre for Applied Psychology, Athabasca University in partial fulfillment of the requirements for the degree of MASTER OF COUNSELLING Alberta August 2009 i

2 DEDICATION This final project is dedicated to the memory of my late grandfather, John Robert Willson. His insatiable quest for higher learning was, and continues to be, an inspiration for my own continuing education. His passing during the final year of my Masters program was difficult and it saddens me that he will not be here to celebrate its completion, as he was undeniably one of my greatest fans. I appreciate every ounce of support and encouragement he gave me to complete this project, even in the final weeks of his life. ii

3 COMMITTEE MEMBERS The members of this final project committee are: Name of Supervisor: Dr. Nancy Arthur Name of Second Reader: Dr. Jeff Chang iii

4 ABSTRACT The conceptualization of perfectionism has shifted from a unidimensional perspective to a multidimensional perspective that allows for the inclusion of positive and potentially enhancing elements, consistent with a shift in psychology toward a more strength-based approach. These two influences highlight a need to articulate treatment implications for how counsellors can work with perfectionistic clients most effectively. This final project provides a review of the multiple elements of perfectionism and how the existing conceptualization of this construct best translates into effective treatment practices. The applied product is a guidebook for counsellors outlining intervention strategies within a positive psychological paradigm that integrates a strength-based orientation to counselling clients with perfectionism. iv

5 ACKNOWLEDGMENTS I would like to express my sincere gratitude to my final project supervisor, Dr. Nancy Arthur. Her support, guidance, and patience, coupled with her tremendous knowledge and expertise, made this an invaluable learning experience. I would also like to acknowledge the contribution of Dr. Jeff Chang as the second reader for this final project and extend my thanks for his time, energy, and input to this process. Lastly, and indeed most importantly, I would like to thank my family and friends for their continuous encouragement throughout a process that sometimes felt like it would never end. The compassionate words, the assistance with editing, and the welcome distractions from my project when I really needed a break were appreciated. Thank you for being the people who stood by and believed in me when I sometimes didn t believe in myself this experience undoubtedly helped me to learn about the true depth of my competence. v

6 TABLE OF CONTENTS DEDICATION. ii ABSTRACT. iv ACKNOWLEDGMENTS.... v TABLE OF CONTENTS. vi CHAPTER I: INTRODUCTION The Current Project. 4 CHAPTER II: THEORETICAL FOUNDATIONS... 5 Conceptualization and Measurement of Perfectionism.. 5 Early Definitions of Perfectionism. 5 Shift to a Multidimensional View of Perfectionism.. 6 Etiology of Perfectionism.. 10 Assessment of Perfectionism. 12 Maladaptive versus Adaptive Elements of Perfectionism. 13 Treatment Implications.. 15 Cognitive-Behavioural Interventions.15 Empirical Support for Interventions.. 16 Difficulties in Treating Perfectionism vi

7 Expanding the Treatment of Perfectionism. 19 Positive Psychology 22 An Overview Applying Positive Psychology to Perfectionism. 26 Summary. 30 CHAPTER III: THE GUIDEBOOK (1-22) CHAPTER IV: SYNTHESIS AND IMPLICATIONS.. 32 Project Implications Project Limitations. 35 Future Research Directions 36 Conclusion. 37 REFERENCES.. 38 vii

8 CHAPTER I: INTRODUCTION The study of perfectionism has spanned several decades and yielded an assortment of remarkable findings, yet there have been numerous and conflicting views about the conceptualization of this construct. In the past, perfectionism was most often viewed as strictly a negative or harmful attribute (Rice, Ashby, & Slaney, 1998), and has been described as the propensity to strive for unrealistic personal standards and make excessively critical selfevaluations (Frost & Marten, 1990). Moreover, perfectionism has consistently and reliably been linked to various forms of psychopathology (Chang, Watkins, & Banks, 2004). In the early 1990 s, a fundamental shift occurred, wherein researchers began to recognize perfectionism as a two-factor, or multidimensional, construct entailing positive (adaptive) elements, in addition to the already identified negative (maladaptive) components (e.g., Enns, Cox, & Clara, 2002; Frost, Heimberg, Holt, Mattia, & Neubauer, 1993; Oliver, Hart, Ross, & Katz, 2001). This reconceptualization of perfectionsim has led many researchers to attempt to differentiate which factors are adaptive from those that are negative. Contradictory results make it difficult to conclude with any certainty which elements of perfectionism are conclusively maladaptive or adaptive. Researchers have tirelessly sought to investigate the severity, typology, and impact of perfectionism across multiple circumstances and conditions to determine which factors seem to uphold the perseveration of perfectionistic behaviours, but their efforts still yield recurrent inconsistencies. Examination of the negative impact of perfectionism positions this construct as an integral factor in dysfunction and psychopathology. Of critical importance is its welldocumented link to depression (e.g., Enns et al., 2002; Rice et al., 1998; Scott, 2007). Furthermore, perfectionism has been associated with disordered eating (Haase, Prapavessis, & 1

9 Owens, 2002), stress and anxiety (Bieling, Israeli, & Antony, 2004), self-criticism and self esteem (Trumpeter, Watson, & O Leary, 2006), and obsessive compulsive disorders (Ashby & Bruner, 2005). In addition to the widely cited negative impact of perfectionism, recent research has also pointed to the existence of a relatively positive and more adaptive type of perfectionism. For example, Ashby and Rice (2002) examined subscales of the earlier and more negatively skewed perfectionism scales and determined that some portions mapped on to an adaptive dimension which they called positive strivings, including the dimensions of personal standards and organization. Their results suggested that this adaptive perfectionism was positively associated with self esteem. Despite the evidence cited to support this link, there still exists a great deal of confusion and uncertainty on this adaptive dimension of perfectionism and how it relates to its maladaptive counterpart (Dibartolo, Frost, Chang, LaSota, & Grills, 2004). Given the pervasive and far-reaching impact of perfectionism and its highly complex nature, it is imperative to identify the most effective and accurate means of conceptualizing this construct. The shift in the conceptualization of perfectionism from a unidimensional to multidimensional construct has occurred alongside a shift in the overall field of psychology toward a more strength-based approach. The turn of the century saw a proliferation of research on positive psychology, following the millennial article by Seligman and Czikszentmihalyi (2000) that urged fellow researchers and practitioners to emphasize human well-being and resilience, as opposed to human dysfunction and pathology. Positive psychology is further described by Sheldon and King (2001) as an attempt to urge psychologists to adopt a more open and appreciative perspective regarding human potentials, motives, and capacities (p. 216). The 2

10 shift in views of perfectionism from a solely negative construct to a multidimensional construct with adaptive features is aligned with this concurrent shift in the field of positive psychology. The conceptual shift in the field of research on perfectionism, as well as the recent emphasis on strength promotion in the field of psychology, suggests a number of implications that are of paramount importance to counsellors. A critical issue is the association between the conceptualization of perfectionism and the determination of treatment directions. If the traditional, maladaptive view of perfectionism is adopted, the treatment direction is one of elimination or reductionism. If perfectionism is viewed as adaptive, however, the treatment direction needs to consider ways to embrace perfectionism while helping clients to enhance performance and mental health. Regardless of which perspective is taken, treatment options prescribed in the literature are limited. Typically, the treatment of perfectionism has been addressed from a cognitive-behavioural stance, that seeks to challenge negative and self-critical thought patterns (e.g., Dibartolo, Frost, Dixon, & Almodovar, 2001; Ferguson & Rodway, 1994). Surprisingly, however, there are few empirical studies to demonstrate the efficacy of this approach in treating perfectionism (Flett & Hewitt, 2007; Shafran & Mansell, 2001). Clearly, the complex and multidimensional nature of perfectionism necessitates the specification and evaluation of interventions for counselling. There clearly exists a void in how the newfound conceptualization of perfectionism and the positive psychology paradigm translates into effective counselling practices. Flett and Hewitt (2004) point out 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 (p. 234). Several years later, these same authors noted the current perfectionism literature to still have a vast deficiency in extensive 3

11 analysis and empirical evaluation of treatment factors (Flett & Hewitt, 2007). Given that many counselling clientele experience perfectionism as a component or mediator in the perpetuation of their counselling issues, it seems that a clarification and clear delineation of effective counselling techniques and strategies would be an essential asset to the field. The Current Project The goal of this project is to a) examine the multiple elements of perfectionism, and, b) elucidate a conceptual stance that enhances counselling interventions. The conceptualization of perfectionism as a multidimensional construct will be explored in light of treatment implications that incorporate elements of positive psychology and focus on the adaptive aspects of perfectionism. The culmination of these efforts will result in the generation of a brief guidebook for counsellors that will serve to assist them in treating clients afflicted by perfectionistic tendencies. Given this intent, a comprehensive literature review will be conducted to examine the available research in this subject area. Following this, the research will be synthesized into a series of recommendations and tangible intervention strategies to assist counsellors in their work with clients. 4

12 CHAPTER II: THEORETICAL FOUNDATIONS Conceptualization and Measurement of Perfectionism Early Definitions of Perfectionism Although the notion of perfectionism has undeniably been in existence for centuries, the research interest in this concept increased exponentially in the last decade of the twentieth century (Bieling et al., 2004). The early conceptualization of this construct viewed perfectionism as unidimensional, possessing only a negative dimension. Researchers tended to describe perfectionism as both an undesirable goal and a debilitating condition wherein individuals strain compulsively and unremittingly toward impossible goals (Pacht, 1984, p. 386). Pacht asserts that the insidious nature of perfectionism leads me to use the label only when describing a kind of psychopathology (p. 387). This negative and maladaptive theme was the norm in the literature and consequently many of the early empirical studies on perfectionism operationalized the construct in this negative manner (Ashby & Rice, 2002). The prevailing message conveyed that perfectionists will ultimately be penalized for their self-defeatist tendency across many domains of their life including, not only decreased productivity, but also impaired health, poor self-control, troubled personal relationships, and low self-esteem (Burns, 1980, p. 34). Hamachek (1978) was one of the early researchers who first alluded to the possibility that the definition of perfectionism may not be a strictly negative construct. Hamachek made a distinction between neurotic and normal perfectionism. Hamachek maintained that neurotic perfectionism usually involves the expectation of an unattainable level of performance that is motivated by fear of failure, and individuals are incapable of being satisfied with their efforts or the outcome due to extremely rigid performance standards. Conversely, he described normal perfectionism as involving adherence to high standards, but with the ability to experience 5

13 satisfaction and a sense of accomplishment, as well as the ability to lessen personal standards in certain situations. Since Hamachek s (1978) early suggestions of a more adaptive side of perfectionism, numerous researchers have pointed to the potentially positive elements of this construct. Reminiscent of Hamachek s early definition of normal perfectionism, Enns et al. (2002) described adaptive perfectionism as, the setting of high goals and personal standards and striving for the rewards associated with achievement while retaining the ability to be satisfied with one s performance (p. 922). Similarly, Parker and Mills (1996) described adaptive perfectionists as individuals with, high standards, a desire to achieve, conscientiousness, or high levels of responsibility (p. 194). The perfectionism literature has seen an increasing amount of research on the more positive and adaptive elements of perfectionism, which has clearly heralded definitions that point to the existence of an inherently positive component of perfectionism Shift to a Multidimensional View of Perfectionism As the view of perfectionism expanded to include a more adaptive component, a corresponding shift was occurring in the re-conceptualization of perfectionism as a multidimensional construct. This fundamental shift in the perfectionism literature was emphasized by the creation of two particular scales designed to measure this construct, both of which were named the Multidimensional Perfectionism Scale, but developed by two separate teams of researchers (MPS-F: Frost, Marten, Lahart, & Rosenblate, 1990; MPS-H: Hewitt & Flett, 1991). Although there are several comparable dimensions that are tapped in each of these scales and represent areas of overlap, there are also some different dimensions that are reflected as well (Scott, 2007). Frost et al. s (1990) measure was designed to assess six dimensions of perfectionism: high personal standards (PS), excessive concern over mistakes (CM), orderliness 6

14 (O), perceived parental expectations (PE), perceived parental criticism (PC), and the tendency to doubt the quality of one s actions (DA). Bieling, Israeli, Smith, and Antony (2003) point out that Frost et al. s measure is centered on a key perfectionism component of critically evaluating one s behaviour, which has regularly been associated with the dysfunctional elements of perfectionism. The second of the two Multidimensional Perfectionism Scales, developed by Hewitt and Flett (1991), focuses largely on the intrapersonal and interpersonal elements of perfectionism (Bieling et al., 2003). Accordingly, their measure includes two dimensions that address the interpersonal domain (socially-prescribed perfectionism [SPP] and other-oriented perfectionism [OOP]), and one that addresses the intrapersonal domain (self-oriented perfectionism [SOP]). These dimensions reflect the source or the object of the perfectionism (Scott, 2007), where SPP is perceived as imposed by others, SOP is directed toward others, and SOP is self-imposed and self-directed. The development of these two multidimensional measurement tools expanded the view of perfectionism as a construct that that could further be broken down to reveal a number of different dimensions (Lundh, 2004). This advancement in conceptualization permitted researchers an opportunity to entertain the idea that although some of the dimensions were, in fact, associated with psychopathology, others were perhaps more benign (Bieling et al., 2004; Frost et al., 1993; Rice et al., 1998; Slade & Owens, 1998). In fact, Frost et al. (1990) point out that, the setting of and striving for high standards is certainly not in and of itself pathological, rather the psychological problems associated with perfectionism are probably more closely associated with these critical evaluation tendencies than with the setting of high personal standards (p. 450). From this point, numerous researchers became captivated with the process of 7

15 delineating which dimensions of perfectionism could be considered adaptive amidst those that had traditionally been considered negative. An early study by Frost et al. (1993) analyzed various dimensions of the two main perfectionism scales (MPS-H and MPS-F) to determine the existence of maladaptive and adaptive factors. Their findings revealed two central components of the perfectionism construct a) Positive Achievement Strivings (PAS; comprised of the PS, O, SOP, and OOP dimensions) and, b) Maladaptive Evaluations Concerns (MEC; comprised of the CM, PC, PE, DA, and SPP dimensions). A seminal finding of this study was the existence of a positive correlation between PAS and positive affectivity, whereas MEC positively correlated with depression and negative affectivity. This represented one of the first empirical results to support the existence of a positive and enhancing form of perfectionism. A similar study was conducted by Dunkley, Blankstein, Halsall, Williams, and Winkworth (2000), where the two key perfectionism scales (MPS-H and MPS-F) were once again examined. They found strong empirical support for the existence of two unique factors within the perfectionism construct, which they termed Personal Standards Perfectionism (comprised of the SOP and PS dimensions) and Evaluative Concerns Perfectionism (comprised of the SPP, CM, and DA dimensions). The findings suggested only the perfectionism that was founded in Evaluative Concerns resulted in psychological distress. Although slightly different studies, the results of both Frost et al. (1993) and Dunkley et al. (2000) point out that distinguishing between striving for high standards and critical evaluation is central to the distinction between maladaptive and adaptive perfectionism. Despite the mounting evidence for a seemingly positive and adaptive element within the conceptualization of perfectionism, there exists a great deal of inconsistency, as the results across 8

16 studies have yielded conflicting views (Dibartolo et al., 2004). One of the primary issues of contention is the component of perfectionism that has been described as striving for high personal standards. Although it has long been considered just as maladaptive as its counterparts, it has become a central concept of study as the main thrust behind adaptive perfectionism (Dibartolo et al., 2004). While some studies continue to echo the sentiments of Frost et al. (1993), debate exists as some studies suggest that measures of high personal standards and selforiented perfectionism are associated with positive adjustment measures, but other studies fail to show a relationship, or may even demonstrate a relationship in the opposite direction (Besser, Flett, & Hewitt, 2004). For example, research by Conroy, Kaye, and Fifer (2007) points out the interconnectedness among the dimensions of perfectionism and consequently asserts all three forms of perfectionism (SOP-self oriented perfectionism, SPP-socially prescribed perfectionism, and OOP-other oriented perfectionism) measured by Hewitt and Flett s scale (MPS-H, 1991), have at least some maladaptive features, although admittedly, some have been found to be more so than others. In a similar vein, Dunkley, Zuroff, and Blankstein (2003) found results that undermine the argument for an adaptive form of perfectionism, as they found these dimensions to be associated with greater negative affect, but had no relation to positive affect. The results of these conflicting studies renders the process of conceptualizing perfectionism an extremely difficult task, suggesting that dimensions of perfectionism will continue to require further investigation. Despite the overall lack of clarity in the definition, conceptualization, and understanding of this elusive construct, the present stance in the recent literature seems to be one of compromise. Lundh, Saboonchi, and Wångby (2008) advocate a perfectionism/acceptance 9

17 theory, which asserts that high personal standards or other strivings for perfection are adaptive when combined with the acceptance of non-perfection (i.e., the acceptance of various kinds of failures, mistakes, and shortcomings), but maladaptive when combined with an inability to accept failures, mistakes, and shortcomings (p. 335). In his earlier paper on this topic, Lundh (2004) points out that the basic premise of his work rests upon his assertion that the difference between positive/adaptive and negative/maladaptive perfectionism can best be understood in terms of the degree of acceptance an individual has regarding the outcome. He states, there is an important distinction between perfectionistic strivings, and perfectionistic demands (p. 256). Lundh (2004) claims there is nothing inherently negative or maladaptive about striving for perfectionism, as this represents healthy human functioning to support the many great feats and accomplishments of humans. However, dysfunction occurs when striving for perfectionism includes a demand for perfectionism that ceases to allow an individual to be anything less than perfect. In a similar vein, Scott (2007) found support for the notion of perfectionism having a neutral core. He suggests that it is not perfectionism per se that leads to dysfunction and instances of psychopathology, rather the circumstances and the consequences that are perceived by the individual. Taken together, these results suggest that perfectionism may not be as pernicious as once thought, and also might not be as enhancing as once thought; rather, it is a complex intertwining of variables that regulate the manifestation of perfectionism in any given circumstance. Etiology of Perfectionism Perfectionism is often cited as originating in developmental factors, although Enns et al. (2002) mention the dearth of empirical research in this area. Much like the early unidimensional 10

18 view of perfectionism, the early etiological perspectives were largely negative as well. Barrow and Moore (1983) described four different types of childhood experiences that can lead to the development of perfectionistic thinking. These include: (1) overtly demanding and critical parents, (2) excessively high parental expectations and standards with implied criticism, (3) absence of standards with inconsistent or absent parental approval, and (4) modeling of perfectionism through parental attitudes and behaviours. At this time, the emphasis was clearly on the manner in which parents can contribute to the development of maladaptive forms of perfectionism, however, the multidimensional conceptualization of perfectionism brought about some further interesting research. Rice, Ashby, and Preusser (1996) examined both maladaptive and adaptive perfectionists and found a difference in the reports of their childhood experiences. Their results suggested a trend wherein maladaptive perfectionists reported their parents to be significantly more critical and demanding than adaptive perfectionists. Given the recent shift to examine the potentially enhancing aspects of perfectionism, researchers have begun to recognize that the developmental origins of adaptive perfectionism will need to be studied if this attribute is to be further understood. Rice and Mirzadeh (2000) add that it is a logical extension for research on adaptive perfectionism to contribute to the development of intervention strategies targeted at enhancing this type of perfectionism. Accordingly, these researchers also attempted to make a distinction between maladaptive and adaptive perfectionists by examining attachment experiences and types of perfectionism among college students. Rice and Mirzadeh found higher levels of reported secure attachment to parents in adaptive perfectionists compared to maladaptive perfectionists. This research places early parenting styles at an even higher level of importance when considering the potential ramifications for perfectionism that children may later exhibit. 11

19 Another recent study by Flett, Hewitt, Oliver, and MacDonald (2002) sought to further differentiate between adaptive and maladaptive perfectionism in terms of early parental influence and the potential development of each type of perfectionism later in life. According to these researchers, it is not high parental expectations per se that lead to maladaptive perfectionism, but rather high expectations that are coupled with high levels of parental criticism. Alternately, when high expectations are paired with warmth (rather than criticism), Flett et al. found support for the development of adaptive perfectionism instead. Taken together, these studies point to the strong theoretical connection that exists between perfectionism and early parent-child relationships (Enns et al., 2002), and suggests that etiological factors represent an important element for consideration when treating individuals with perfectionism. Assessment of Perfectionism Two of the main perfectionism scales that are still the most commonly used are the two Multidimensional Perfectionism Scales developed by Frost et al. (1990) and Hewitt and Flett (1991). As mentioned previously, these scales played an integral role in facilitating the shift in perfectionism from a unidimensional to a multidimensional construct. Although some positive elements were eventually identified within these scales, their initial formulations represented negatively skewed assessment tools. Ashby and Rice (2002) point out that of the six dimensions measured by Frost et al. s Multidimensional Perfectionism Scale, all subscales sought to measure negative mental health characteristics and concerns, aside from the two subscales measuring personal standards and orderliness. Furthermore, Bieling et al. (2004) assert that these two most commonly used measures of perfectionism were derived from a negative perspective that views perfectionism as a personality feature that is damaging and in need of modification. They mention the need for researchers to strive for the development of assessment tools that 12

20 encompass the notion of an adaptive component of perfectionism and bring up the importance of constructing appropriate measurement tools that accurately assess all underlying constructs. Slaney and Ashby (1996) further investigated the notion that perfectionism could have both adaptive and maladaptive elements, and in association with other researchers developed an assessment tool called the Almost Perfect Scale-Revised (APS-R: Slaney, Rice, Mobley, Trippi, & Ashby, 2001). This tool was designed with the intention to tap the potentially positive dimensions of perfectionism, while still assessing the conventionally more maladaptive elements of perfectionism as well. Specifically the scale contains 23 items designed to assess three subscales (Standards, Order, and Discrepancy). According to these authors, standards, in and of themselves, are a positive dimension of striving for enhanced performance, and order is a positive factor of organization. Perfectionism is only maladaptive when discrepancy exists between expectations and perceived performance capacity. The advent of this scale certainly suggests that researchers have begun to modify their assessment tools to exemplify the more adaptive elements of perfectionism and provide more ample representation of the multiple dimensions of the perfectionism construct. Maladaptive versus Adaptive Elements of Perfectionism Given the proclivity of perfectionism research to focus on the negative elements of this construct, there are innumerable studies that provide evidence for a strong link between perfectionism and psychological distress. The well-established linkage between perfectionism and depression is one of the most heavily researched areas, and has consistently shown that maladaptive perfectionism is strongly correlated with depression (Rice & Mirzadeh, 2000), but this consistency is not without exceptions. An interesting finding by Enns et al. (2002) 13

21 demonstrated that maladaptive perfectionism showed a significant correlation with depression proneness, while adaptive perfectionism demonstrated an inverse relationship with depression. Maladaptive perfectionism typically results in negative evaluations of one s performance due to high performance standards (Rice et al., 1998), which involves excessive concern over mistakes and a preoccupation with living up to the expectations of others (Rice & Ashby, 2007). This mindset of unremitting perfectionistic standards that maladaptive perfectionists ascribe to can result in fear of failure (Conroy et al., 2007), greater levels of stress (Chang et al., 2004), and increased anxiety (Arthur & Hayward, 1997; Bieling et al., 2004; Parker, 1997). Maladaptive perfectionism is also associated with decreased self esteem and confidence (Ashby & Rice, 2002), increased feelings of inferiority (Ashby & Kottman, 1996), insecure adult relationships (Rice, Lopez, & Vergara, 2005), poor coping skills (Blankstein & Lumley, 2008), and suicide ideation (Chang et al., 2004; O Connor & Forgan, 2007). There clearly exists a plethora of evidence to suggest that perfectionism is a pernicious attribute that should be evaded and abolished at all costs; however, there exists a relatively more adaptive and enhancing side of perfectionism as well. Adaptive perfectionism is related to many elements of academic achievement including positive academic and social adjustment (Brown et al., 1999; Rice & Dellwo, 2002), better academic integration (Rice & Mirzadeh, 2000), conscientiousness (Parker, 1997), and academic achievement (Enns, Cox, Sareen, & Freeman, 2001). Additionally, adaptive perfectionism is correlated with overall emotional and psychological well-being including greater positive affect (Frost et al., 1993; Rice & Slaney, 2002), higher self-esteem (Ashby & Rice, 2002), a greater sense of general self-efficacy (LoCicero & Ashby, 2000), and more secure relationships than maladaptive perfectionists (Rice et al., 2005). Furthermore, adaptive perfectionists have more positive coping skills (Blankstein & 14

22 Lumley, 2008), an internal locus of control (Periasamy & Ashby, 2002) and better emotionalregulating strategies than maladaptive perfectionists, likely because they have emotional selfsoothing or regulatory mechanisms to maintain and enhance their healthy psychological functioning (Aldea & Rice, 2006, p. 506). The conflicting studies on perfectionism leave both researchers and practitioners in a position of uncertainty about the potentially enhancing aspects of perfectionism. Given that a great deal of evidence exists to support incompatible or opposing perspectives of perfectionism, tremendous difficulty arises in formulating treatment interventions and strategies. Treatment Implications As noted in the previous section, the majority of research has discussed the conceptualization of perfectionism and its negative impact, while fewer studies exist that connect research to the treatment of perfectionism. Several researchers have pointed to the paucity of research that exists on empirically validated treatment interventions for perfectionism (e.g., Shafran & Mansell, 2001; Flett & Hewitt, 2007), although some researchers have added valuable contributions to the literature in this area (e.g., Arpin-Cribbie et al., 2008; Kutlesa, 2002; Kutlesa & Arthur, 2008). Cognitive-Behavioural Interventions Despite the initial lack of empirical research to formally support the utility of cognitivebehavioural interventions for perfectionism, this treatment approach for perfectionism represents a common theme throughout the literature. Many studies have made recommendations for treating perfectionism that are rooted in cognitive-behavioural practices, but these suggestions are largely based upon theoretical assumptions or clinical experience, and derived from 15

23 extensions of data, rather than empirical examinations of the treatment methodology itself (e.g., Blankstein & Winkworth, 2004; Dibartolo et al., 2001; Flett, Madorsky, Hewitt, & Heisel, 2002). Investigating a client s cognitive distortions is typically a key element of any cognitivebehavioural intervention strategy. For example, Ashby and Rice (2002) stress the importance of addressing a perfectionistic client s all or nothing thinking in order to lessen rigid standards, as well as other common distortions such as disqualifying the positive and magnification and minimization. Furthermore, Besser et al. (2004) stress the importance of examining automatic thoughts, and Bieling et al. (2003) point out the utility of cognitive techniques such as a costbenefit analysis that involve examining evidence for the pros and cons of maintaining perfectionistic beliefs. According to Besser et al. (2004) a beneficial method of working with perfectionists is via cognitive interventions that focus on the overall objective of developing a more flexible approach to goal setting and attainment, and modifying evaluative sets so that they can come to regard their performance with more satisfaction (p. 323). Altogether, these researchers all point to the importance and utility of implementing cognitive-behavioural strategies in working with perfectionistic clients. Empirical Support for Interventions Ferguson and Rodway (1994) conducted one of the first studies that sought to demonstrate the empirical efficacy of cognitive-behavioural interventions in treating perfectionism. Their study found support for this approach, as clients experienced a considerable reduction in their levels of perfectionism, evidenced by decreases in overall levels of selfcriticism, difficulty dealing with feedback, procrastination, and unrealistic goal setting as a result of the cognitive-behavioural interventions. Another study by DiBartolo et al. (2001) found support for cognitive-behavioural interventions in treating perfectionism. Specifically, their 16

24 results suggested that cognitive restructuring techniques were effective in reducing elements of unhealthy perfectionistic thinking, such as reducing anxiety for tasks and increasing participants ratings of ability to cope. More recently, support has also been found for cognitive-behavioural interventions delivered in different formats. Pleva and Wade (2006) evaluated the effectiveness of the cognitive-behavioural self-help strategies developed by Antony and Swinson (1998) in their book titled When Perfect Isn t Good Enough. They found support for the efficacy of the self-help strategies in this book, as the participants in their study exhibited significant reductions in perfectionistic tendencies. Another format that has proved successful as a means of delivering a cognitivebehavioural intervention strategy is group treatment (Kutlesa, 2002; Kutlesa & Arthur, 2008). This research utilized a structured set of cognitive-behavioural lessons delivered to the group by the researcher. The results suggested the group intervention was successful in reducing all three of Flett & Hewitt s (1991) types of perfectionism (SOP, OOP, SPP), as well as demonstrating significant decreases in depression and anxiety. The most recent support for cognitive-behavioural approaches in ameliorating perfectionism comes from a web-based psycho-educational intervention (Arpin-Cribbie et al., 2008). The results demonstrated that this treatment modality was successful in reducing levels of perfectionism, depression, and automatic negative thoughts. Taken together, these studies demonstrate support for cognitive-behavioural interventions in treating perfectionism and highlight the vast number of different approaches that fit within a cognitive-behavioural methodology. 17

25 Difficulties in Treating Perfectionism Despite the acknowledged effectiveness of cognitive-behavioural techniques in treating perfectionism, Flett and Hewitt (2008) stated, while the significant reductions in levels of perfectionism as a result of treatment are noteworthy, we caution that perfectionism is a relatively enduring trait; thus, some perfectionists will remain treatment resistant and overall levels of perfectionism may remain relatively high even when significant improvements are realized (p. 127). Other researchers have also pointed out that perfectionism can be particularly difficult to treat when clients perceive it to be serving a particular purpose or associated with substantial benefits (Lundh, 2004; Scott, 2007). An additional difficulty in treating perfectionism may also be due to the perception of perfectionism that exists in the larger societal culture, wherein perfectionism is often tolerated and even encouraged due to the belief that perfectionism is associated with important rewards in areas such as sports, business, and academics (Bieling et al., 2004). In a qualitative study carried out by Slaney and Ashby (1996), some of the perfectionists that were interviewed saw their perfectionism as an entirely positive trait that they would be reluctant to renounce even if given the opportunity to do so. Perfectionism can also specifically interfere with the course of treatment in counselling. Blatt, Quinlan, Pilkonis, and Shea (1995), found that intense perfectionism was significantly associated with poorer treatment outcomes for depression patients, whereas those with lower levels of perfectionism were relatively responsive to brief forms of treatment for depression. Lundh (2004) suggests that elevated levels of perfectionism are also likely to hinder the overall therapeutic process, as the client may set overly perfectionistic therapeutic goals, perceive perfectionistic demands for therapeutic change from the therapist or significant others, or even have perfectionistic expectations of the therapist or the treatment methodology itself. 18

26 Furthermore, research has been done to compare maladaptive and adaptive perfectionists on their expectations about counselling. Oliver et al. (2001) found that adaptive perfectionism (characterized by a large component of self-oriented perfectionism, and an absence of sociallyprescribed perfectionism) is significantly associated with positive expectations for many aspects of counselling including expectations of the client, counsellor, and the process and outcome of counselling. They added that by extension of these results, it is plausible that maladaptive perfectionism (characterized by a large component of SPP socially-prescribed perfectionism and an absence of SOP self-oriented perfectionism) may be associated with more negative expectations about counselling and may discourage individuals from seeking counselling. This study provides support for the notion of perfectionism having an adaptive or enhancing dimension, and suggests that it may be highly amenable for counselling interventions. Expanding the Treatment of Perfectionism Despite the foreboding warning regarding the intractability of perfectionism to treatment interventions and the limited scope of cognitive-behavioural treatment methodologies, evidence for expanded treatment modalities is mounting alongside the shifting conceptualization of perfectionism. As researchers endorse the notion that perfectionism has the potential to contain elements that are adaptive and enhancing, the means of effective treatment strategies must also evolve to accommodate this shift. Given the prevailing medical model of the twentieth century, much of the treatment for perfectionism has traditionally been focused on pathology and the reduction of negative symptoms. This reflects the medical model s focus on combating illness and dysfunction from a highly reactive stance that fails to encompass the holistic nature of individuals. Cowan and Kilmer (2002) point out one of the many limitations of the medical model to be its limited 19

27 effectiveness in dealing with longstanding dysfunction. Given that perfectionistic tendencies have been cited as being rooted in childhood experiences (Frost, Lahart, & Rosenblate, 1991; Hamachek, 1978), the longstanding duration of this condition would likely not be as effectively addressed under the medical model. When the focus was on a unidimensionally negative conceptualization, the goal of treatment was to reduce or ultimately eliminate perfectionistic tendencies; however, the shift in perfectionism to endorse a multidimensional and more positive outlook has impacted treatment modalities by moving away from an approach solely rooted in the eradication of perfectionism. Researchers are now acknowledging that it may be more realistic to view the treatment of this elaborate construct as a compromise between the maladaptive and adaptive elements of perfectionism (e.g., Rice, Vergara, & Aldea, 2006). When counselling highly perfectionistic individuals, it is important that the interventions assist clients in maintaining the more adaptive elements of perfectionism, such as their high personal standards, but simultaneously examine the maladaptive elements inherent in the cognitive distortions that are perpetuating the existence of the maladaptive components (Ashby & Rice, 2002). Lundh (2004) also endorses this compromise, as he believes it is not necessary to undermine a client s perfectionistic strivings, as these are typically natural and functional; rather, there needs to be a process of developing a more accepting stance toward imperfection that may serve as a corrective to an unbalanced perfectionism (p. 265). This process of compromise can be viewed as an attempt to balance the harmful and beneficial elements of perfectionism in order to achieve a state of equilibrium for the client wherein their perfectionism is not all-encompassing, but instead self-serving. Some researchers have taken this line of inquiry even further to suggest that a more positive model that focuses on client strengths and resiliency is needed in the treatment of 20

28 perfectionism. Rice et al. (1998) refer to the tendency in the literature to study the maladaptive nature of perfectionism as highly counteractive to the positive, developmental perspective that many counsellors emphasize in their work with clients. They believe an increased focus on the adaptive aspects of perfectionism will provide these counsellors with a vehicle for enhancing client strengths while simultaneously transforming and moderating the adverse consequences of maladaptive perfectionism. Overall, the results of the Rice et al. (1998) study suggest that a counselling psychologist working with a perfectionistic client should: (a) consider the possibility that some adaptive elements of perfectionism are present in the client, (b) assess perfectionism as a multidimensional construct, and (c) when possible, work with the strengths of the adaptive perfectionism in the therapeutic process (p. 312). The notion of this more positive stance to perfectionism treatment is evident in more recent literature as well. Blankstein, Lumley, and Crawford (2007) point out the importance of counsellors working to increase levels of protective variables in their clients. Their study suggested that optimism and social support were both potentially important buffers to the negative impact of perfectionism. Similarly, Rudolph, Flett, and Hewitt (2007) remark on the need for a resilient and adaptive approach that provides interventions to increase positive cognitive coping skills to serve as a buffer to the more negative cognitive coping skills perfectionists often exhibit. Some of this research may reflect the dramatic shift observed at the turn of the century that ushered in the newfound emphasis on positive psychology. This movement has seen psychology focus more strategically on building strengths and competencies rather than merely treating deficits and disorders (Miller, Nickerson, Chafouleas & Osborne, 2008, p. 679). Given that the conceptual shift in understanding the construct of perfectionism has moved from negative (maladaptive) to positive (adaptive) it seems plausible 21

29 that the tenets of positive psychology could effectively contribute to useful treatment recommendations. Positive Psychology An Overview In a seminal article on positive psychology, Seligman and Csikszentmihalyi (2000) brought forth an important message, to remind our field that psychology is not just the study of pathology, weakness, and damage; it is also the study of strength and virtue (p. 7). They acknowledge that since World War II the field of psychology has operated within the prevailing medical model, which focuses on the assessment of dysfunction and pathology. Cowen and Kilmer (2002) assert that the mental health field has typically functioned in a reactive rather than proactive mode, waiting for problems to manifest and then mobilizing to contain or repair malfunction. They add that two of the major shortcomings of the dominant medical model are its limited reach and applicability to diverse groups in need, and effectiveness with longstanding dysfunction (p. 450). The earlier conceptualization of perfectionism that viewed the construct as unidimensionally negative likely reflects this medical model and the related focus on mental illness as opposed to emotional well-being. Seligman and Csikszentmihalyi (2000) point out that from an evolutionary standpoint the medical model does make a certain degree of logical sense. This is because negative emotions typically produce an alarm response, due to their association with immediate problems or objective dangers, which compels individuals to stop and assess the situation and their behaviour. Conversely, the experience of positive emotions usually passes by without acknowledgement, appreciation, or recognition because no alarm response is indicated and thus, people are blinded to the survival value of positive emotions (Seligman & Csikszentmihalyi, 22

30 2000, p. 13). The roots of the deficit-focused medical model are clearly ingrained in our societal outlook on mental health, but it is encouraging to note that evidence exists to support the value of focusing on a strength-based orientation by utilizing positive psychology principles in working with clients (Seligman, Steen, Park, & Peterson, 2005). The findings of positive psychology are viewed as valuable for practitioners to further enhance client interventions (Foster & Lloyd, 2007), yet some researchers have remarked on the void that exists in linking the tenets of positive psychology to the daily work of counselling psychologists (Harris, Thoreson, & Lopez, 2007). Consequently, there have been limited strategies and interventions that enable positive psychology to traverse the gap from theory to practice. Despite the paucity of research in this area, Harris et al. have put forth some general strategies for incorporating positive psychology into the therapeutic milieu including the identification of strengths and use of strength-oriented language, and expanding the framework of problem conceptualization and assessment. They note the language used to describe client concerns is often shrouded with weakness and deficit, and suggest that counsellors strive to incorporate language that identifies client s strengths and resources. A related notion of assessing and conceptualizing client concerns points to the tendency in the medical model to frame problems solely in terms of deficits or the presence of something negative. Harris et al. encourage the use of assessment and intake procedures that incorporate the identification of strengths and resiliencies to be supported and maintained in the counselling process. Another attempt to navigate the void between positive psychology theory and practice was offered by Lopez and Snider (2003), in the book titled, Positive Psychological Assessment: A Handbook of Models and Measures. This resource provides practitioners with a guide to integrate the assessment of human strengths and resources into their work with clients. The 23

31 practical value of this publication is evident in its applied tools and offers a variety of perspectives to help with the incorporation of theoretically grounded positive measures in to the field of counselling psychology. The difficulty in translating theory to practice is joined by the additional obstacle of backing these positive psychological interventions with empirical results. In a study that attempted to garner support for an evidence-based practice of positive psychology, Seligman et al. (2005) tested five interventions that purportedly increase individual happiness. Their results suggested that three of the interventions significantly increased happiness and decreased depressive symptoms for up to six months. In addition to this, further studies have attempted to examine the application of the theoretical tenets of positive psychology to particular areas of applied psychology (without necessarily involving empirical data). For example, Miller and Nickerson (2007) examined how several areas of research on positive psychological constructs (i.e., gratitude, optimism, mindfulness, etc.) could potentially be applied to adolescents receiving counselling interventions in schools. Miller et al. (2008) also embarked on an application of positive psychological constructs to an applied field of psychology. Specifically, they discussed how the application of the tenets of positive psychology to a specific group (school psychologists) could enhance both their level of functioning and their level of personal satisfaction and fulfillment. Although both articles are admittedly conceptual in nature and did not conduct empirical research, they argue that positive psychology could be applied to their proposed research directions. Additionally, these articles provide a wealth of information and suggested strategies to incorporate positive psychology into applied settings. Despite the mass appeal of positive psychology, it is important to note that researchers in this area are not staging a complete overhaul of the medical model that emphasizes deficit and 24

32 pathology, but instead advocating the use of strength promotion to augment the existing model (Harris et al., 2007; Seligman et al., 2005). Miller and Nickerson (2007) note that treatment rooted in a positive psychological approach should be used not to supplant, but rather to supplement, other evidence-based psychotherapeutic interventions (e.g., cognitive-behavioral therapy) (p. 149). While Harris et al. (2007) purport that a focus on strengths and positive psychology in the counselling environment must be clearly supported by an alignment with explicit counselling goals, they still remain avid supporters of a strength-based model. Harris et al. sum up their rationale for strength promotion as follows: It is possible that, in certain situations, the growth and maintenance of positive characteristics and behaviors may ensure the absence of the negative characteristics and behaviors. It is possible that by encouraging the growth of strengths, we as counselors can simultaneously reduce the negative states we are explicitly paid to reduce In effect, we might get 2-for-1. For example, by increasing the amount of time a client spends thinking grateful and calming thoughts, there is simply less time and attentional resources to think upsetting and unhelpful thoughts. If one assumes that attention is a zero-sum game, the most efficient way to reduce negative thoughts and emotions and increase positive ones may be to focus on increasing the positive. (p. 4) The growing body of research that incorporates positive psychology constructs into treatment interventions represents an encouraging and promising approach. These strategies characterize interventions that focus on building competence and fostering resiliency because treatment is not just fixing what is broken; it is nurturing what is best (Seligman & Csikszentmihalyi, 2000, p. 7). What remains to be seen, however, is how the burgeoning field of 25

33 positive psychological constructs can be applied to specific conceptual areas such as perfectionism. Applying Positive Psychology to Perfectionism Although no research has yet been done to evaluate that application of positive psychology principles to the treatment of perfectionism, there are several reasons to suspect that the resulting outcome would prove fruitful. Given the intense fear of failure, concern over mistakes and negative performance evaluations that perfectionists regularly focus on, it would seem fitting that perfectionistic clients would be ideal candidates for a strength promotion approach to counselling. Perfectionistic individuals also have a tendency to focus explicitly on perceived flaws and inadequacies, thus a shift toward examining the positive elements of their character would likely be extremely beneficial. Moreover, the aforementioned intractability of perfectionism to treatment interventions necessitates a diversified approach (Flett & Hewitt, 2008). Thus the inclusion of elements of positive psychology may be extremely beneficial to address the multidimensional aspects of perfectionism. The findings by Oliver et al. (2001) suggest adaptive perfectionism is more amenable to treatment and further propose that fostering a healthy, adaptive type of perfectionism may provide benefits in the counselling milieu. As mentioned in the previous section, the goal of a positive psychological approach is to infuse these elements into existing treatment models that have demonstrated efficacy in outcomes (Harris et al., 2007), e.g., cognitive behavioral approaches. In fact, Harris et al. point out that in many cases there is an overlap between traditional interventions rooted in the medicalmodel and the newer strength-based interventions. They noted that cognitive restructuring, which is a common technique used across several theoretical orientations can be used from a pathologyfocused perspective, when disputing irrational thoughts in the tradition of rational-emotive 26

34 therapy, or alternately from a strength-based approach, by helping clients learn more constructive and helpful ways of thinking. The key element that makes each treatment methodology unique is a distinct difference in focus; however, it is evident that significant overlap exists among the two approaches. Several positive approaches have been suggested as ways of addressing perfectionism in a therapeutic setting. Given that perfectionism is now understood to be a more complicated, multidimensional construct, researchers have pointed to the need to both assess and educate clients based on this expanded conceptualization. Ashby and Bruner (2005) have pointed to the importance of counsellors taking the time to thoroughly assess a client s perfectionism to distinguish between adaptive and maladaptive forms. Rice and Mirzadeh (2000) echo this sentiment by deeming it a necessity for counsellors to assess the typology of perfectionism (p. 176) in order to best assist the client. This represents a useful strategy to help establish accurate and effective goals and interventions for the therapeutic process, as elements of adaptive perfectionism can be enhanced, while elements of maladaptive perfectionism can be disputed. To assist in this assessment process, Rice and Ashby (2007) worked extensively on the Almost Perfect Scale Revised (APS-R: Slaney et al., 2001) to develop straightforward calculations and cutoff scores that can be utilized to classify potential perfectionists. Their study established an accessible method for quickly scoring the APS-R to classify individuals as maladaptive perfectionists, adaptive perfectionists, or non-perfectionists. This study certainly provides counsellors with a practical means of assessing clients perfectionism to further augment their treatment. In addition to the assessment of perfectionism itself to reveal any potentially enhancing elements, positive psychological theory suggests that clients should also be assessed for their 27

35 overall strengths, as this may elucidate protective variables and coping skills to assist in treatment (Blankstein et al., 2007; Rudolph et al., 2007). An attempt to quantify human strengths was undertaken by Peterson and Seligman (2004) with the creation of an instrument called the VIA Signature Strengths Inventory, which is an online assessment that measures positive traits and allows individuals to identify their most salient strengths. This tool comes from their handbook titled Character Strengths and Virtues: A Handbook and Classification, which represents an ambitious attempt to systematically describe and classify human strengths and virtues that encourage human thriving. In stark contrast to the Diagnostic and Statistical Manual s (DSM) emphasis on deficit and pathology, the handbook and inventory created by Peterson and Seligman offers a resource that reflects the existence of six core virtues: wisdom, courage, humanity, justice, temperance, and transcendence (Foster & Lloyd, 2007). The VIA Signature Strengths Inventory taps into these six core virtues to identify the psychological components that comprise the character strengths. This tool represents a way of making positive psychology accessible and functional, in a format that practitioners could utilize in their work with clients. Related to the notion of assessing clients perfectionism and strengths is the need for psychoeducation on the dimensions of perfectionism (Aldea & Rice, 2006). Oliver et al. (2001) point out maladaptive perfectionists, in particular, could benefit from psychoeducation around its maladaptive aspects to shed light on the ways in which they are perpetuating their negative perfectionistic tendencies. This would likely improve their ability to actively engage in the counselling process with positive results, as they may recognize their tendency to hold unattainable standards could impede in counselling and therefore work with the counsellor to set more reasonable goals for counselling. Likewise, Ashby and Bruner (2005) suggest that the 28

36 process of assessing perfectionism should be paired with psychoeducation that addresses the notion of perfectionism having possibly detrimental, as well as potentially more benign consequences. The notion of educating clients on perfectionism could also be further extended to include a preventative psychoeducational treatment element for parents. This would outline the relationship between parenting styles and the etiological roots of perfectionism in childhood developmental experiences. The early prevention of maladaptive perfectionism through working with parents to educate them on parenting styles and the impact they have on shaping their child s future experiences could prove useful in curtailing the negative impact of perfectionism that may later arise in their children. In addition to educating clients on the negative aspects of perfectionism to create awareness of the conditions they are perpetuating via their behaviours, it is also essential to provide psychoeducation on adaptive perfectionism. Educating clients on the adaptive elements of perfectionism is important in protecting them from a perceived attack on their character when addressing their perfectionism in treatment. Flett and Hewitt (2007) point out the extreme difficulty in giving up perfectionism because for many clients the need to be perfect has become an integral component of their identity. Therefore, clients are less likely to feel threatened and as though they are being stripped of their perfectionistic identity if they are able to identify some positive elements of their perfectionism that can still be retained. Another element of psychoeducation on the adaptive elements of perfectionism is the importance of drawing attention to a strength-promotion orientation that focuses on what is going well as opposed to what is going wrong. The essence of this perspective involves giving clients hope and something to strive for in the future. Miller and Nickerson (2007) point out that hope and optimism are fundamental elements of a positive psychological approach and that 29

37 counsellors should seek to impart these traits to their clients. Supporting clients in establishing a deeper understanding of the multidimensional nature of their perfectionism will assist in this process, particularly when the maladaptive elements of perfectionism are appropriately balanced with the adaptive and enhancing elements that can instill a sense of hope. Summary This literature review outlined the theoretical foundations of perfectionism and provided an account of the conceptual development that has impacted the definition, assessment, measurement, and treatment of this complex construct. Given the shifting conceptualization and the numerous conflicting results across the studies, it is undeniably important to assist practitioners in their understanding of perfectionism and in treatment strategies for their clients. The recent emphasis on positive psychological approaches provides an impetus for looking at ways that we can infuse the treatment of perfectionism with a strength-based approach to better meet the needs of diverse clientele. Given the identified need for helping clients to address their experience of perfectionism, a guidebook for counsellors that includes strategies for working with perfectionistic clients in a positive and enhancing fashion will now be presented. A few points should be noted in regards to this guidebook. It is important to acknowledge that this resource was created with the specific intention of meeting the needs of the target audience, which was identified as counsellors working with perfectionistic clients. Consequently, it was considered of paramount importance to ensure ease-of-use, brevity, and that information provided was both relevant and succinct. To this end, APA formatting of the guidebook has been relaxed to allow for a reader-friendly format that is more visually appealing. Despite this modification, all reference citations are included to ensure that research sources are properly credited and the guidebook concludes with an APA formatted reference section. 30

38 T REATING P ERFECTIONISM P OSITIVELY: A COUNSELLOR S G UIDEBOOK T O I NTERVENTION S TRATEGIES B Y S TEPHANIE W ILLSON 31 Page 1

39 T ABLE OF C ONTENTS Introduction What is Perfectionism?... 3 Multidimensional View of Perfectionism Maladaptive vs. Adaptive Perfectionism: Comparison Chart. 5 Why Be Concerned about Perfectionism?... 6 What is the Verdict Is Perfectionism Good or Bad?... 7 Perfectionism Treatment: Strategies and Tools Sample Vignettes INTRODUCTION Resources and Further Information 13 The impetus behind this guidebook was to join References two areas of psychology to illustrate how they could be used to enhance counselling services. Appendix A: Almost Perfect Scale Revised Initially, the negative view of perfectionism Appendix B: Values in Action: Inventory of Strengths seemed like an incompatible match with positive psychology. However, upon closer examination of the construct of perfectionism, it made a lot of sense to look at it from the point of view of positive psychology. The application of positive psychology principles to the conceptualization and treatment of perfectionism is an innovative approach that holds great promise. As perfectionism has evolved to include an element of positive and enhancing factors, a need for new treatment strategies has also emerged the answer to which is positive psychology. The specific intent of this guidebook was to create a practical and accessible resource to assist counsellors and their clients in achieving the following outcomes: 1. Increased knowledge of perfectionism concepts; 2. Deepened understanding of how perfectionism impacts clients; 3. Tools and approaches for building positive treatment strategies; and, 4. Resources to access for further information. The scope of the material is focused on individual adult counselling clientele. This focus was selected as it was deemed relevant for the greatest number of counsellors and clients. Additionally, the majority of research on perfectionism has been with adult populations. Despite the guidebook s emphasis on individual adult counselling as the main population it serves, the resource section on page 12 provides additional references on other populations and treatment modalities for the reader to access (i.e., perfectionism in children, group treatment modalities). Perfectionism is an elusive and often misinterpreted concept. It is hoped that counsellors who work with perfectionistic clients will find information in this guidebook that assists them in building more comprehensive and effective treatment plans that are connected to a strengthbased orientation. Page 2

40 WHAT IS PERFECTIONISM? The term perfectionism appears to be descriptive and relatively straightforward in that it defines or labels one s state of being perfect. However, the broader conceptualization of this construct holds numerous implications and repercussions related to the complexity of perfectionism. When defining perfectionism, it is important to consider the context in which this construct has developed over the past several decades. Perfectionism has traditionally been viewed in solely negative terms, as a debilitating and undesirable condition with strictly negative ramifications (Rice, Ashby, & Slaney, 1998). Much of the past literature on perfectionism was slanted in this fashion, as the early conceptualization of this construct viewed perfectionism as unidimensional, possessing only a negative dimension (Ashby & Rice, 2002). In more recent years, however, researchers have pointed to the potential for a more adaptive and enhancing side to perfectionism (Ashby & Rice, 2002). This has led to the conceptualization of perfectionism as a multidimensional perspective. In this way, perfectionism is seen as containing many elements that include both adaptive and maladaptive components. M ALADAPTIVE P ERFECTIONISM THE SETTING OF INFLEXIBLE AND/ OR UNATTAINABLY HIGH STANDARDS, THE INABILITY TO TAKE PLEASURE IN ONE S PERFORMANCE AND UNCERTAINTY OR ANXIETY ABOUT ONE S CAPABILITIES ADAPTIVE P ERFECTIONISM THE SETTING OF HIGH GOALS AND PERSONAL STANDARDS AND STRIVING FOR THE REWARDS ASSOCIATED WITH ACHIEVEMENT WHILE RETAINING THE ABILITY TO BE SATISFIED WITH ONE S PERFORMANCE (ENNS, COX, & CLARA, 2002, P. 922) 33 Page 3

41 M ULTIDIMENSIONAL VIEW OF PERFECTIONISM A dramatic shift occurred in the 1990 s when researchers began to identify the construct of perfectionism as more intricate and complex than originally thought. This reconceptualization opened a new door in the perfectionism literature as researchers began to discuss a number of different dimensions. While some of these dimensions were indeed associated with pathology and dysfunction, there was now a clear potential for other more benign and perhaps even enhancing elements to exist as well (Bieling, Israeli, & Antony, 2004). Seminal research by Hewitt and Flett (1991) outlined three dimensions of perfectionism that have since been extensively studied, and focus on both the intrapersonal and interpersonal elements of perfectionism (Bieling, Israeli, Smith, & Antony, 2003). Self-oriented perfectionism (SOP) addresses the intrapersonal domain, while socially-prescribed perfectionism (SPP) and otheroriented perfectionism (OOP) addresses the interpersonal domain. These dimensions reflect the source or object of the perfectionism (Scott, 2007), where SPP is perceived as imposed by others, OOP is directed toward others, and SOP is self-imposed and self-directed. Although inconsistencies exist across studies, it has been suggested that SPP is the more maladaptive perfectionism dimension, while SOP embodies more potentially adaptive elements of perfectionism (Dunkley, Blankstein, Halsall, Williams, & Winkworth, 2000). S ELF-ORIENTED P ERFECTIONISM SETTING HIGH STANDARDS FOR ONESELF AND USING THOSE STANDARDS TO EVALUATE PERFORMANCE O THER-ORIENTED P ERFECTIONISM HOLDING OTHERS TO HIGH STANDARDS AND EVALUATING OTHERS CRITICALLY WHEN THEY FAIL TO MEET THOSE STANDARDS S OCIALLY-PRESCRIBED P ERFECTIONISM BELIEF THAT OTHERS ARE HOLDING ONE TO HIGH STANDARDS AND PRESSURING THEM TO BE PERFECT (ASHBY & RICE, 2002) Given this new distinction within the perfectionism construct, researchers have rigorously attempted to dissect the many elements of perfectionism to determine which elements can be deemed positive or adaptive, and which are negative or maladaptive. Countless studies have been conducted, yielding many interesting results, however consensus has yet to be reached on many of the linkages perfectionism has to certain conditions. The following chart outlines some of the common results and themes in the research on adaptive and maladaptive perfectionism. Although this format is useful in terms of ease of organization, it does not capture the complexity that exists in distinguishing between the adaptive and maladaptive elements of perfectionism; thus, it is important to keep in mind that these results are not always conclusive or irrefutable, and research continues to clarify the nature of perfectionism. 34 Page 4

42 M ALADAPTIVE P ERFECTIONISM Increased anxiety (Arthur & Hayward, 1997) Greater levels of stress (Chang, Watkins, & Banks, 2004) Increased feelings of inferiority (Ashby & Kottman, 1996) Decreased self esteem and confidence (Ashby & Rice, 2002) Increased levels of depression (Rice & Mirzadeh, 2000) Suicide ideation (O Connor & Forgan, 2007) Constant negative evaluations of one s performance (Rice et al., 1998) Excessive concern over mistakes (Rice & Ashby, 2007) Fear of failure (Conroy, Kay, & Fifer, 2007) Higher external locus of control (Periasamy & Ashby, 2002) Little or no academic advantages (Rice & Mirzadeh, 2000) Increased procrastination (Rice et al., 1998) Poor coping skills (Blankstein & Lumley, 2008) Insecure adult relationships (Rice, Lopez, & Vergara, 2005) ADAPTIVE P ERFECTIONISM Improved emotional regulating strategies (Aldea & Rice, 2006) Greater sense of general selfefficacy (LoCicero & Ashby, 2000) Increased self esteem (Ashby & Rice, 2002) Increased positive affect and overall psychological wellbeing (Frost, Heimberg, Holt, Mattia, & Neubauer, 1993; Rice & Slaney, 2002) Ability to be satisfied with one s performance (Enns et al., 2002) Greater acceptance of an imperfect outcome (Lundh, 2004) Higher internal locus of control (Periasamy & Ashby, 2002) Positive academic achievement (Enns, Cox, Sareen, & Freeman, 2001) Conscientiousness (Parker, 1997) More positive coping skills (Blankstein & Lumley, 2008) More secure adult relationships (Rice, Lopez, & Vergara, 2005) 35 Page 5

43 WHY BE CONCERNED ABOUT PERFECTIONISM? S OCIETAL I NFLUENCE: Perfectionism is a complex phenomenon that is often misunderstood. Messages in society are often distorted to reflect the view that it is admirable and even encouraged to be perfectionistic. This is due to the belief that perfectionism is associated with important rewards or benefits in areas such as sports, business, and academics (Bieling et al., 2004). Many researchers caution against the perpetuation of this assumption, as perfectionism is a pervasive, persistent, and powerful personality construct that is enduring, and often resistant to treatment (Flett & Hewitt, 2008). C OMORBIDITY: Treating perfectionism is a unique task because clients rarely seek counselling to address their perfectionistic tendencies per se; rather it is other symptoms or behaviours that are associated or linked to the client s perfectionism. The comorbidity of perfectionism with other conditions necessitates the unravelling of multiple client issues. The presence of perfectionism can sometimes even aid in the perseveration of other conditions (e.g., see Blatt, Quinlan, Pilonis, & Shea, 1995). This makes it of paramount importance for counsellors to be on the lookout for indications that perfectionism may be present and bring this to the forefront of the treatment strategy. T REATMENT I NTERFERENCE: The perfectionism construct itself has also been shown to interfere with the course of treatment in counselling. Elevated levels of perfectionism can hinder the overall therapeutic process, as the client may set overly perfectionistic therapeutic goals, perceive perfectionistic demands for therapeutic change from the therapist or significant others, or even have perfectionistic expectations of the therapist or the treatment methodology itself (Lundh, 2004). 36 Page 6 E TIOLOGY: The enduring aspect of perfectionism likely stems from its etiology, which most researchers agree can be traced back to childhood developmental factors. When the earlier, strictly negative view of perfectionism was endorsed, the research focused on how certain types of parenting contributed to the development of negative forms of perfectionism; citing demanding and critical parenting, excessively high expectations, and inconsistent parental approval as common factors (Barrow & Moore, 1983). The more recent multidimensional conceptualization of perfectionism has pointed to some adaptive elements by pointing out that it is not high parental expectations per se that lead to maladaptive perfectionism, but rather high expectations that are coupled with high levels of parental criticism (Flett, Hewitt, Oliver, & MacDonald, 2002). Alternately, when high expectations are paired with warmth (as opposed to criticism), these researchers found support for the development of adaptive perfectionism instead.

44 WHAT IS THE VERDICT... IS PERFECTIONISM GOOD OR BAD? Despite the fact that multitudinous studies have been published on adaptive and maladaptive perfectionism, there is still a number of conflicting results that can make the interpretation of these constructs extremely difficult. Consequently, the present stance in the literature seems to agree that the best fit for the data is one of compromise in conceptualizing perfectionism. Both adaptive perfectionists and maladaptive perfectionists are focused on striving for high performance expectations and goals; however, the key difference is the tolerance of imperfection. Thus, it is possible to strive for perfection in a healthy manner without necessarily requiring or demanding perfection if an individual s self worth it is not contingent on the requirement of a perfect outcome (Lundh, 2004). More recent research by Lundh and his colleagues has identified this approach as the perfectionism/acceptance theory. P ERFECTIONISM/ACCEPTANCE T HEORY - HIGH PERSONAL STANDARDS OR OTHER STRIVINGS FOR PERFECTION ARE ADAPTIVE WHEN COMBINED WITH THE ACCEPTANCE OF NON-PERFECTION ( I. E., THE ACCEPTANCE OF VARIOUS KINDS OF FAILURES, MISTAKES, AND SHORTCOMINGS), BUT MALADAPTIVE WHEN COMBINED WITH AN INABILITY TO ACCEPT FAILURES, MISTAKES, AND SHORTCOMINGS (LUNDH, SABOONCHI, & WÅNGBY, 2008, P. 335) The bottom line is that perfectionism is neither entirely bad, as was once thought, or entirely good. There are some elements that are clearly detrimental to an individual s well-being, but others that can bring about a more positive and enhancing element. Consequently, the real question becomes, how do we adapt our treatment strategies to foster and augment what is positive about perfectionism, while simultaneously reducing the negative impacts? 37 Page 7

45 PERFECTIONISM TREATMENT: STRATEGIES AND TOOLS When the focus was on a unidimensionally negative conceptualization, the goal of treatment was to reduce or ultimately eradicate perfectionistic tendencies. However, the shift in perfectionism to endorse a multidimensional and more positive outlook has impacted treatment modalities. There are some factors of perfectionism that we may not want to eliminate. When counselling highly perfectionistic individuals, it is important that the interventions assist clients in maintaining the more adaptive elements of perfectionism, such as their high personal standards, but simultaneously examine the maladaptive elements inherent in the cognitive distortions that are perpetuating the existence of the maladaptive components (Ashby & Rice, 2002). M EDICAL M ODEL VERSUS P OSITIVE P SYCHOLOGY: The early conceptualization of perfectionism was largely influenced by the prevailing medical model of the twentieth century, thus treatment traditionally focused on pathology and the reduction of negative symptoms. This reflects the medical model s focus on combating illness and dysfunction from a highly reactive stance that fails to encompass the holistic nature of individuals. A pivotal shift has occurred however, in which the field of psychology has moved toward a greater focus on the notion of positive psychology which calls for a renewed focus on human strengths and virtues (Seligman & Csikszentmihalyi, 2000). Given the intense fear of failure, concern over mistakes and negative performance evaluations that perfectionists regularly engage in, it would seem fitting that perfectionistic clients would be an exceptional candidate for strength promotion. Perfectionistic individuals also have a tendency to focus explicitly on perceived flaws and inadequacies, thus a shift toward examining the positive elements of their character would likely be extremely beneficial. Given that the conceptual shift in understanding the construct of perfectionism has moved from solely negative to the inclusion of positive features it seems plausible that the tenets of positive psychology could effectively contribute to useful treatment recommendations. C OGNITIVE-BEHAVIOURAL I NTERVENTIONS: Traditionally, the treatment of perfectionism had centered upon cognitive-behavioural interventions that focus on a client s cognitive distortions. For example, Ashby and Rice (2002) emphasize the importance of addressing a perfectionistic client s all or nothing thinking in order to lessen rigid standards, as well as other common distortions such as disqualifying the positive and magnification and minimization. Besser, Flett, and Hewitt (2004) add the importance of engaging in the process of examining automatic thoughts. Bieling et al. (2003) point out the utility of cognitive techniques such as a cost-benefit analysis that involves examining evidence for the pros and cons of maintaining perfectionistic beliefs. 38 Page 8

46 P OSITIVE P SYCHOLOGY I NTERVENTIONS: The intent of the positive psychological approach is not necessarily to usurp the approach of the medical model or dismiss the preexisting cognitive-behavioural treatment strategies that were already shown effective in treating perfectionism. Instead, the goal of a positive psychological approach is to infuse these elements into the existing model (Harris, Thoreson, & Lopez, 2007). There are three particular areas of positive psychology that are most important for consideration when working with perfectionistic clients: 1) Perfectionism Assessment a. Counsellors need to assess a client s perfectionism as a multidimensional construct and with the assumption in mind that some adaptive elements of perfectionism are present (Rice et al., 1998). b. It is essential for counsellors to determine the typology of a client s perfectionism to delineate which elements are maladaptive and which are adaptive in order to establish appropriate and effective interventions (Ashby & Bruner, 2005). c. Practical tool: Almost Perfect Scale Revised (see Appendix A) This is a brief scale that measures elements of maladaptive and adaptive perfectionism to allow for the assessment of an individual s perfectionism. 2) Strength Promotion a. Counsellors need to increase their focus on the adaptive aspects of perfectionism in the therapeutic intervention. This focus provides a vehicle for enhancing client strengths while simultaneously transforming and moderating the adverse consequences of maladaptive perfectionism (Rice et al., 1998). b. Counsellors seek to identify and increase the level of protective variables (i.e., optimism and social support) that buffer the client s experience of the negative impact of perfectionism (Blankstein, Lumley, & Crawford, 2007). c. Counsellors attempt to utilize strength-based language as often as possible. Harris et al. (2007) note the language used to describe client concerns is often shrouded with weakness and deficit, and suggest that counsellors strive to incorporate language that identifies client s strengths and resources. d. Practical tool: Values in Action: Inventory of Strengths (see Appendix B) This is a scale that identifies client strengths and virtues, presenting them in a tangible and accessible manner that isolates a client s top five strengths. 39 Page 9

47 3) Psychoeducation a. Counsellors need to take the time to educate clients on various dimensions of perfectionism (Aldea & Rice, 2006) b. Educating clients about the potentially negative impact of perfectionism on the therapeutic process can improve a client s ability to actively engage in the counselling by creating an increased awareness of this barrier in working toward goals (Oliver, Hart, Ross, & Katz, 2001). c. Educating clients about the potentially positive elements of perfectionism facilitates the counselling process by providing reassurance that it is not necessary to completely renounce their perfectionism. Given that perfectionism often becomes an integrated component of clients identity that they are reluctant to give up (Slaney & Ashby, 1996), pointing out the positive elements will help to instill a sense of hope for treatment outcomes. It is clear from the growing body of research on positive psychology that improved treatment interventions result from a system that focuses on building competence and fostering resiliency because treatment is not just fixing what is broken; it is nurturing what is best (Seligman & Csikszentmihalyi, 2000, p. 7) 40 Page 10

48 SAMPLE VIGNETTES Monica is a 19 year old post-secondary student who made an appointment at the university counselling center to discuss her concerns about her academic performance. She reports elevated levels of stress and anxiety, and mentions to her counsellor that she is constantly worrying about her school work. Monica has extremely high expectations for her grades and describes her academic accomplishments as a defining part of me. Monica finds herself procrastinating, but clarifies that the problem is not that she doesn t get around to doing her school work, but rather she works tirelessly on it without ever being able to finish. Monica reports that she simply cannot hand something in unless she is certain that she will receive a mark of 90% or greater. Simon is a 28 year old executive for a rapidly advancing software company who reluctantly made a counselling appointment through the employee assistance program to discuss his depressive symptoms. He reports feeling immense pressure to present the outward image of a successful and thriving businessman that continuously performs at the top of the field. When asked about his job, Simon states, I just feel like I am never quite good enough... there is a constant expectation of higher sales, better programming, and longer hours of work. The experience of a minor blunder is seen as catastrophic and leads Simon to ruminate incessantly over his mistakes. He reports that his overall unhappiness with his lifestyle is wearing on him and he is not sleeping well. He says he doesn t know what to do. Audrey is a 33 year old who seeks counselling to discuss her dissatisfaction within her intimate relationship and the present level of conflict and distress. She reports feeling continuously disappointed with her partner and that he is always letting her down and not acting the way she desires. She can t understand why he always messes up and believes that his behaviours result in her feelings of inadequacy and negativity about herself. Audrey discloses to her counsellor that she feels very angry a lot of the time and doesn t always know why, or how to deal with it. She states that she does not understand why they can t just live the ideal vision of a blissfully happy couple. 41 Page 11

49 VIGNETTE Q UESTIONS FOR CONSIDERATION: 1) What are the negative or maladaptive aspects of perfectionism that are apparent in the description of each vignette? 2) What are the positive or adaptive aspects of perfectionism that are apparent in the description of each vignette? 3) Which of the three types of perfectionism (socially-prescribed, selforiented, and other-oriented) comes to mind as the dominant dimension in each of the three vignettes? Is there sometimes overlap, with more than one dimension present? 4) How could you work with the client in each of these situations to address the maladaptive perfectionism, while also working to enhance the adaptive and enhancing elements (i.e. positive strivings)? 42 Page 12

50 RESOURCES AND FURTHER INFORMATION Lopez, S. J., & Snyder, C. R. (Eds.). (2003). Positive psychological assessment: A handbook of models and measures. Washington, DC: American Psychological Association. Antony, M.M., & Swinson, R.P. (1998). When perfect isn t good enough: Strategies for coping with perfectionism. Oakland, CA: New Harbinger Publications. These authors have since published a second edition (2009) of their self-help book that focuses on strategies for coping with perfection. The most recent edition offers the benefit of the most up-to-date research in the field. Their book offers a unique edge in that its utility as a self-help tool in the treatment of perfectionism has been empirically validated (Pleva & Wade, 2006). This handbook represents one of the first attempts to bring positive psychology theory into practical application in the counselling milieu. This publication provides practitioners with a guide to integrate the assessment of human strengths and resources into their work with clients. A variety of perspectives are offered to help with the incorporation of theoretically grounded positive measures in to the field of applied counselling psychology. G ROUP T REATMENT FOR P ERFECTIONISM: Kutlesa, N. (2002). A group intervention with university students who experience difficulties with perfectionism. (Doctoral dissertation, University of Calgary, 2002). Dissertation Abstracts International, 64(2-A), 398. Kutlesa, N., & Arthur, N. (2008). Overcoming negative aspects of perfectionism through group treatment. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 26, T REATING P ERFECTIONISM IN C HILDREN: Schell, C. M. (2006). Overcome by Perfection: A Treatment Manual for Children with Perfectionism. Campus Alberta Applied Psychology Final Project. This document is accessible through the Athabasca University Digital Thesis and Project room via the following link: 43 Page 13

51 References Aldea, M.A., & Rice, K.G. (2006). The role of emotional dysregulation in perfectionism and psychological distress. Journal of Counseling Psychology, 53(4), Arthur, N., & Hayward, L. (1997). The relationships between perfectionism, standards for academic achievement, and emotional distress in postsecondary students. Journal of College Student Development, 38(6), Ashby, J.S., & Bruner, L.P. (2005). Multidimensional perfectionism and obsessive-compulsive behaviors. Journal of College Counseling, 8, Ashby, J.S., & Kottman, T. (1996). Inferiority as a distinction between normal and neurotic perfectionism. Individual Psychology, 52, Ashby, J.S., & Rice, K.G. (2002). Perfectionism, dysfunctional attitudes, and self esteem: A structural equations analysis. Journal of Counseling and Development, 80, Barrow, J. C., & Moore, C. A. (1983). Group interventions with perfectionist thinking. Personnel and Guidance Journal, 61, Besser, A., Flett, G.L., & Hewitt, P.L. (2004). Perfectionism, cognition, and affect in response to performance failure vs. success. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 22(4), Bieling, P.J., Israeli, A.L., & Antony, M.M. (2004). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36, Bieling, P.J., Israeli, A., Smith, J., & Antony, M.M. (2003). Making the grade: The behavioural consequences of perfectionism in the classroom. Personality and Individual Differences, 35, Blankstein, K.R., & Lumley, C.H. (2008). Multidimensional perfectionism and ruminative brooding in current dysphoria, anxiety, worry, and anger. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 26, Blankstein, K.R., Lumley, C.H., & Crawford, A. (2007). Perfectionism, hopelessness, and suicide ideation: Revisions to diathesis-stress and specific vulnerability models. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 25(4), Blatt, S. J., Quinlan, D. M., Pilkonis, P. A., & Shea, M. T. (1995). Impact of perfectionism and need for approval on the brief treatment of depression: The National Institute of Mental Health Treatment of Depression Collaborative Research Program revisited. Journal of Consulting and Clinical Psychology, 63, Chang, E.C., Watkins, A.F., & Banks, K.H. (2004). How adaptive and maladaptive perfectionism relate to positive and negative psychological functioning: Testing a stress-mediation model in black and white college students. Journal of Counseling Psychology, 51(1), Conroy, D.E., Kaye, M.P., & Fifer, A.M. (2007). Cognitive links between fear of failure and perfectionism. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 25(4), Page 14

52 Dunkley, D.M., Blankstein, K.R., Halsall, J., Williams, M., & Winkworth, G. (2000). The relation between perfectionism and distress: Hassles, coping, and perceived social support as mediators and moderators. Journal of Counseling Psychology, 47(4), Enns, M.W., Cox, B.J., & Clara, I. (2002). Adaptive and maladaptive perfectionism: Developmental origins and associations with depression-proneness. Personality and Individual Differences, 33, 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. (2008). Treatment interventions for perfectionism a cognitive perspective: Introduction to the special issue. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 26, Flett, G. L., Hewitt, P. L., Oliver, J. M., & MacDonald, S. (2002). Perfectionism in children and their parents: A developmental analysis. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp ). Washington, DC: APA. Frost, R.O., Heimberg, R.G., Holt, C.S., Mattia, J.I., & Neubauer, A.L. (1993). A comparison of two measures of perfectionism. Personality and Individual Differences, 14, Harris, A.H.S., Thoreson, C.E., & Lopez, S.J. (2007). Integrating positive psychology into counseling: Why (and when appropriate) how. Journal of Counseling and Development, 85, Hewitt, P.L., & Flett, G.L. (1991). Perfectionism in the self and in social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, LoCicero, K.A., & Ashby, J.S. (2000). Multidimensional perfectionism and self-reported self-efficacy in college students. Journal of College Student Psychotherapy, 15, Lundh, L.G. (2004). Perfectionism and acceptance. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 22(4), Lundh, L.G., Saboonchi, F., & Wångby, M. (2008). The role of personal standards in clinically significant perfectionism. A person-oriented approach to the study of patterns of perfectionism. Cognitive Therapy and Research, 32, O Connor, R.C., & Forgan, G. (2007). Suicidal thinking and perfectionism: The role of goal adjustment and behavioral inhibition/activation systems (BIS/BAS). Journal of Rational-Emotive & Cognitive- Behavior Therapy, 25(4), Oliver, J.M., Hart, B.A., Ross, M.J., & Katz, B.M. (2001). Healthy perfectionism and positive expectations about counselling. North American Journal of Psychology, 3(2), Parker, W.D. (1997). An empirical typology of perfectionism in academically talented children. American Educational Research Journal, 34, Periasamy, S., & Ashby, J.S. (2002). Multidimensional perfectionism and locus of control: Adaptive vs. maladaptive perfectionism. Journal of College Student Psychotherapy, 17(2), Page 15

53 Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook and classification. Washington, DC: American Psychological Association. Rice, K.G., & Ashby, J.S. (2007). An efficient method for classifying perfectionists. Journal of Counseling Psychology, 54, Rice, K.G., Ashby, J.S., & Slaney, R.B. (1998). Self-esteem a mediator between perfectionism and depression: A structural equations analysis. Journal of Counseling Psychology, 45(3), Rice, K.G., Lopez, F.G., & Vergara, D. (2005). Parental/social influences on perfectionism and adult attachment orientations. Journal of Social and Clinical Psychology, 24, Rice, K.G., & Mirzadeh, S.A. (2000). Perfectionism, attachment, and adjustment. Journal of Counseling Psychology, 47(2), Rice, K.G., & Slaney, R.B. (2002). Clusters of perfectionists: Two studies of emotional adjustment and academic achievement. Measurement and Evaluation in Counseling and Development, 35, Scott, J. (2007). The effect of perfectionism and unconditional self-acceptance on depression. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 25(1), Seligman, M.E.P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), Seligman, M.E.P., Steen, T.A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), Slaney, R. B., & Ashby, J. S. (1996). Perfectionists: Study of a criterion group. Journal of Counseling and Development, 74, Slaney, R. B., Mobley, M., Trippi, J., Ashby, J. S., & Johnson, D. (1996). Almost Perfect Scale-Revised, Unpublished scale, The Pennsylvania State University, University Park. Slaney, R. B., Rice, K. G., Mobley, M., Trippi, J., & Ashby, J. S. (2001). The revised almost perfect scale. Measurement and Evaluation in Counseling and Development, 34, Page 16

54 Appendix A Almost Perfect Scale Revised (APS-R) Slaney, R. B., Rice, K. G., Mobley, M., Trippi, J., & Ashby, J. S. (2001). The revised almost perfect scale. Measurement and Evaluation in Counseling and Development, 34, This scale is unique in that it represents the first deliberate attempt to measure the potentially positive aspects of perfectionism. The APS-R was designed to tap prospective positive aspects of perfectionism, while still also assessing the traditionally negative and problematic aspects of perfectionism as well (Ashby & Rice, 2002). The psychometric properties of this measure have been extensively studied and attained tremendous support (Rice & Ashby, 2007). This self-report measure contains 23 items that are responded to on a 7-point Likert scale where 1 = strongly disagree and 7 = strongly agree. Three subscales are derived from the APS-R. The Discrepancy subscale consists of items that measure the defining negative aspect of perfectionism. It focuses on the perception of failure in meeting high standards; specifically, the perceived difference between the standards held for oneself and actual performance. The other two subscales measure the more positive aspects of perfectionism. The High Standards subscale consists of items that measure high personal standards and performance expectations. The Order subscale consists of items that measure preferences for order and organization. Higher scores represent greater standards, preferences for order, and discrepancy (Rice & Ashby, 2007). All 23 questions of the APS-R are listed on the following page. Scoring Subscales: Standards = 1, 5, 8, 12, 14, 18, 22 Order = 2, 4, 7, 10 Discrepancy = 3, 6, 9, 11, 13, 15, 16, 17, 19, 20, 21, 23 Copyright 1996 by Slaney, Mobley, Trippi, Ashby, & Johnson. Reprinted with permission. Given that researchers have pointed to the need to assess clients perfectionism (Ashby & Bruner, 2005; Rice & Mirzadeh, 2000), Rice and Ashby (2007) responded to this identified need by attempting to identify a practical and efficient way that counsellors could use to classify perfectionists. Building upon the initial parameters of the scale, Rice and Ashby worked extensively on the APS-R to develop a set of straightforward cut off scores that can be used to quickly classify clients as maladaptive perfectionists, adaptive perfectionists, or non-perfectionists. Their results suggested the following cut off criteria: High Standards subscale 42 = perfectionist ( 42 = non-perfectionist) If a perfectionist, Discrepancy subscale 42 = maladaptive perfectionist ( 42 = adaptive perfectionist) (Rice & Ashby, 2007, p. 81) 47 Page 17

55 Almost Perfect Scale-Revised The following items are designed to measure attitudes people have toward themselves, their performance, and toward others. There are no right or wrong answers. Please respond to all of the items. Use your first impression and do not spend too much time on individual items in responding. Respond to each of the items using the scale below to describe your degree of agreement with each item Strongly Slightly Slightly Strongly Disagree Disagree Disagree Neutral Disagree Agree Agree 1. I have high standards for my performance at work or at school. 2. I am an orderly person. 3. I often feel frustrated because I can t meet my goals. 4. Neatness is important to me. 5. If you don t expect much out of yourself, you will never succeed. 6. My best just never seems to be good enough for me. 7. I think things should be put away in their place 8. I have high expectations for myself. 9. I rarely live up to my high standards. 10. I like to always be organized and disciplined. 11. Doing my best never seems to be enough. 12. I set very high standards for myself. 13. I am never satisfied with my accomplishments. 14. I expect the best from myself. 15. I often worry about not measuring up to my own expectations. 16. My performance rarely measures up to my standards. 17. I am not satisfied even when I know I have done my best. 18. I try to do my best at everything I do. 19. I am seldom able to meet my own high standards of performance. 20. I am hardly ever satisfied with my performance. 21. I hardly ever feel that what I ve done is good enough. 22. I have a strong need to strive for excellence. 23. I often feel disappointment after completing a task because I know I could have done better. Copyright 1996 by Slaney, Mobley, Trippi, Ashby, & Johnson. Reprinted with permission. 48 Page 18

56 Appendix B Values in Action: Inventory of Strengths (VIA-IS) This measure is taken from the publication Character Strengths and Virtues: A Handbook and Classification by Peterson and Seligman (2004) in which the researchers attempt to classify and quantify widely valued positive traits. This represents one of the most ambitious attempts to highlight the importance of psychological well-being and human thriving. The handbook identifies 24 specific strengths under six broad virtues that consistently emerged across history and culture: wisdom, courage, humanity, justice, temperance, and transcendence. An outline of this classification system can be found on page 22. The VIA-IS is a self-report scale that consists of 240 questions that assess character strengths and identifies an individual s top five strengths. Responses are recorded using a 5- point Likert scale that ranges as follows: Very Much Like Me Like Me Neutral Unlike Me Very Much Unlike Me. The assessment typically takes minutes to complete. Counsellors are encouraged to use this assessment tool in their work with clients to identify and cultivate strengths and virtues. The identification of strengths is useful in looking at a client s perfectionism and attempting to elucidate the positive and enhancing elements that can be fostered. Additionally, a client s strengths and virtues can be used to engage in a conversation about resiliency and coping skills that can be called upon to counteract the more negative and maladaptive elements of perfectionism. Dr. Seligman has made this measurement tool, along with several others, available on his website Authentic Happiness at University of Pennsylvania, which focuses on the study of positive psychology. The steps below outline the process for accessing this assessment tool. How to Take the VIA-IS Online: 1) Go to the web address: (The screen should look like the one pictured below in Screen Shot 1 ) 2) To do the test, you must first register on the site (registration is free). Click on Register, found at the far left in the top navigation bar (see red arrow in Screen Shot 1). Fill in the necessary information and click on the register button to submit your information. Remember to make a note of your login (which will be the you register) along with your password. 3) After registering, the site will transfer you to the Authentic Happiness Testing Center page, which should look like the Screen Shot 2. Scroll down to the Engagement Questionnaires table (in the second table on the page) and next to the VIA Signature Strengths Survey click on the Take Test button (see red circle in Screen Shot 2). 4) When you are finished the test, you will have the option to print out a copy of your results. 49 Page 19

57 Screen Shot 1 Screen Shot 2 Page 5020