Do Your Best, Just Don’t Hurt Yourself

On a semi-regular…er, once a week or so… basis, one of many clients will refer to me as a hypocrite. Sometimes directly, sometimes indirectly. I’ve had weeks when I’ve worked six days straight. I have been known to drink too much coffee in order to offset lack of sleep. And I can be very focused on removing those little fringes from torn sheets of notebook paper.

Here’s the thing. I am a happy person, I have self-esteem, I love my family, I love my little spot in suburbia, and I love my job. People who end up in my office have some combination of unhappy, worthless core beliefs, self-injury, have difficulty forming valued relationships, feel disconnected, hate others, cling to others, restrict their eating, are anxious, and yes I could continue.

Perfectionism is almost like a cute beauty mark with a biopsy indicating it’s a malignant tumor in need of treatment. Fine on the surface while it festers, but eventually it’s going to become blatantly obvious to everyone it’s a problem. The plus to perfectionism is that treatment is more about hanging on to what works – such as achievement – and learning to let go of what doesn’t work – harsh self-appraisal, self-punishment, etc.

So when is perfectionism helpful?

When it’s adaptive perfectionism (some researchers refer to it as conscientiousness). Adaptive perfectionism is all of that great perfectionism you know and love – grades, promotions, goals, beauty, “doing the right thing,” competitive spirit, sense of accomplishment, and more – without all of the self-loathing, insecurity, and at times life-threatening behavior. We call that stuff maladaptive perfectionism.

How does you know when you’re engaging in adaptive vs maladaptive perfectionism?

One being able to accept disappointment if things do not go as planned, and not viewing these events as some sort of confirmation of inferiority. Maybe the Easter ham was overcooked. Maybe you failed an exam. Maybe you bought the wrong socks for your partner. It happens.

Another is something I’ve seen in my practice is how perfectionists motivate themselves. It often has a moral tone to it. Recurrent themes include a sense of responsibility to others (and objects in those with Hoarding Disorder) and being worthwhile to friends, family, or peers. People may criticize themselves or ritualistically engage in self-injury in order to punish themselves when they do not meet their very high standards. Those engaging in adaptive perfectionism do not do this or are at least in the process of challenging these thoughts and behaviors when they occur. They use more positive reinforcement with themselves, such as tangible rewards for a job well done or use of cheerleading statements.

Ultimately, adaptive perfectionism meets the goals of perfectionism: being the best possible and feeling good about it. Perfectionism can be broken down into subcategories, which is for another blog post.

I’m sold on the idea of adaptive perfectionism, but I’m skeptical about my ability to change.

Which is normal. The plus is that Cognitive Behavior Therapy, CBT for short (That therapy the dusting, straightening yours truly uses), is helpful for maladaptive perfectionism. CBT teaches perfectionists to challenge their thinking, practice self-kindness, and improve efficiency.

Another promising treatment is Radically Open Dialectical Behavior Therapy, or RO-DBT for short. It isn’t widespread, though that will likely change when more clinicians are trained.

Alright, I will give it a shot.

Contact Cortney Modelewski at 269-389-0402 or cortney@cortneymodelewski.com

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I put things off

This is awesome: Why Procrastinators Procrastinate

I think it’s true for many procrastinators. Though I found it didn’t entirely reflect my procrastination experiences, because hey, we’re all different and what not. That said, I don’t think my experiences are particularly unique.

I procrastinate. Sometimes for hours, sometimes days. In college and grad school, weeks. Feedback on my work in college included such gems as:

“The paper is still warm from the printer.”

“I would not have guessed you had written this in forty-five minutes.”

“Great Job! 100%”

It was the 100% assignments that kept me afloat throughout school. And reinforced the procrastination to a degree.

Overall, procrastination was a means of avoiding work. Very aversive work.

chart

 

It didn’t seem to make a difference whether or not I started assignments the day assigned or the night before they were due – my thoughts were still a distorted train wreck. So I put things off – I wasn’t exactly going to rush into self-deprecation and misery.

Things improved when I was no longer in college, when what is now considered important is incredibly different than what was. Things also improved when I figured out how to work without the thought train wreck  – I learned to change my thinking.

 

 

 

The Day After Christmas and This Book I’m Reading

The cover of the book I’m reading has a picture of someone cutting grass with a pair of scissors. It’s called Cognitive-Behavioral Treatment of Perfectionism, and it has the most amusing cover of any  clinical book I’ve read to date. The content is not particularly humorous, but it’s interesting.

Reading the section on the causes of perfectionism prompted my mind to go back to Monday, when I was having talking to my dad about cloned lifeforms, identity, family skeletons that paraded out of that closet years ago, and personality traits. And a slew of other things, but the personality discussion sticks out. My dad and I tend to be competitive and tend to make it a point to focus energy on things in which we are skilled at. We differ in that my dad used to be impulsive – things change with age – and I am not.

At all.

Avoiding risk isn’t entirely an anxiety thing with me – it’s lack of interest. I just don’t find impulsive behavior appealing. I can put off enjoyable things for extended periods of time. My idea of a good time after work is looking at pictures of cats on the Internet. I’m not sure if I can explain it any better than just saying meh.

Nature and nurture is a funny thing.

Suicide Attempts as Traumatic Events

I spend a lot of time talking about suicide with clients, and for many it’s the centerpiece of therapy agendas for months. In the case of DBT, it’s tracked on a diary card (log of symptoms, emotions, and skills used). During behavioral or CBT sessions, I usually do a verbal check-in and a PHQ-9 every four weeks. I have one client right now who isn’t experiencing suicidal thinking to some degree. That I’m aware of, anyway; this person could be keeping something from me.

I went to the Beck Institute training on CBT for Depression and Suicidality, which was very fabulous and worth attending if you are a clinician. Of the many things I learned, one was a protocol on suicide prevention. Part of the protocol – and we were told we often wouldn’t do this with folks due to time constraints and client readiness – is on treating suicide attempts as traumatic events

How we (therapists who use therapies related to CBT) treat traumatic events is through prolonged exposure – the person tells their story and listens to their story on recording over and over and over, amongst other things. The trainer said the process used  is sort of like prolonged exposure and stressed we seek supervision should we decide to do it.

I’ve known attempting suicide is frequently traumatic for people. It doesn’t take much brain power to figure that out. What hadn’t clicked until then was my clients don’t describe suicide attempts as traumatic. They may bring up traumatic events during hospitalization, restraints in particular. The suicide itself, no. I’m not entirely sure why, and I plan on asking those who’ve made attempts about it.