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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

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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.

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COMMITTEE MEMBERS

The members of this final project committee are:

Name of Supervisor:

Dr. Nancy Arthur

Name of Second Reader:

Dr. Jeff Chang

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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.

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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.

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TABLE OF CONTENTS

DEDICATION�����������������������������. ii

ABSTRACT������������������������������. iv

ACKNOWLEDGMENTS����������������������...�.� v

TABLE OF CONTENTS�������������������������. vi

CHAPTER I: INTRODUCTION�����������������..����.. 1

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�������������... 18

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Expanding the Treatment of Perfectionism�����������. 19

Positive Psychology����������������������� 22

An Overview����������������������... 22

Applying Positive Psychology to Perfectionism���������. 26

Summary���������������������������. 30

CHAPTER III: THE GUIDEBOOK�������������������... 31 (1-22)

CHAPTER IV: SYNTHESIS AND IMPLICATIONS������������.. 32

Project Implications����������������������.... 33

Project Limitations�����������������������. 35

Future Research Directions�������������������� 36

Conclusion��������������������������. 37

REFERENCES���������������������������.. 38

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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 self-

evaluations (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 well-

documented 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, &

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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

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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

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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.

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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

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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

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(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

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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

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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 self-

oriented 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

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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

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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.

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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

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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)

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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 &

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Lumley, 2008), an internal locus of control (Periasamy & Ashby, 2002) and better emotional-

regulating strategies than maladaptive perfectionists, likely because they have �emotional self-

soothing 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 cognitive-

behavioural 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

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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 cognitive-

behavioural 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 cost-

benefit 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 self-

criticism, 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

17

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 cognitive-

behavioural 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.

18

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.

19

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 socially-

prescribed 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

20

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

21

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

22

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,

23

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

24

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

25

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

26

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 medical-

model 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 pathology-

focused perspective, when disputing irrational thoughts in the tradition of rational-emotive

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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

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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

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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

30

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.

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T R E A T I N G P E R F E C T I O N I S M P O S I T I V E L Y : A C O U N S E L L O R � S G U I D E B O O K T O

I N T E R V E N T I O N S T R A T E G I E S

B Y S T E P H A N I E W I L L S O N

Page 1

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INTRODUCTION The impetus behind this guidebook was to join two areas of psychology to illustrate how they could be used to enhance counselling services. Initially, the negative view of perfectionism 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 strength-based orientation.

TA B L E O F CO N T E N T S Introduction�����������������..�����..�.� 2What is Perfectionism?......................................................................... 3Multidimensional View of Perfectionism��..��������.�..... 4Maladaptive 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�..�����.�...... 8

Sample Vignettes�..�����������������.��� 11

Resources and Further Information�������������� 13

References���������������������............. 14Appendix A: Almost Perfect Scale�Revised�����...�..�.... 17Appendix B: Values in Action: Inventory of Strengths.���.�... 19

Page 2

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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 AL AD AP T I V E PE R F E C TI O N I S M � � T H E S E T T I N G O F I N F L E X I B L E A N D / O R U N A T T A I N A B L Y H I G H S T A N D A R D S , T H E I N A B I L I T Y T O T A K E P L E A S U R E I N O N E � S P E R F O R M A N C E A N D U N C E R T A I N T Y O R A N X I E T Y A B O U T O N E � S C A P A B I L I T I E S �

AD AP T I V E PE R F E C T I O N I S M � � T H E S E T T I N G O F H I G H G O A L S A N D P E R S O N A L S T A N D A R D S A N D S T R I V I N G F O R T H E R E W A R D S A S S O C I A T E D W I T H A C H I E V E M E N T W H I L E R E T A I N I N G T H E A B I L I T Y T O B E S A T I S F I E D W I T H O N E � S P E R F O R M A N C E �

( E N N S , C O X , & C L A R A , 2 0 0 2 , P . 9 2 2 )

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MULTIDIMENSIONAL VIEW OF PERFECTI ONISM

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 re-conceptualization 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 other-oriented 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).

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.

S E L F - O R I E N T E D P E R F E C T I O N I S M � � S E T T I N G H I G H S T A N D A R D S F O R O N E S E L F A N D U S I N G T H O S E S T A N D A R D S T O E V A L U A T E P E R F O R M A N C E �

O T H E R - O R I E N T E D P E R F E C T I O N I S M � � H O L D I N G O T H E R S T O H I G H S T A N D A R D S A N D E V A L U A T I N G O T H E R S C R I T I C A L L Y W H E N T H E Y F A I L T O M E E T T H O S E S T A N D A R D S �

S O C I A L L Y - P R E S C R I B E D P E R F E C T I O N I S M � � B E L I E F T H A T O T H E R S A R E H O L D I N G O N E T O H I G H S T A N D A R D S A N D P R E S S U R I N G T H E M T O B E P E R F E C T �

( A S H B Y & R I C E , 2 0 0 2 )

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M AL AD AP T I V E

PE R F E C T I O N I S M AD AP T I V E PE R F E C T I O N I S M

• Increased anxiety (Arthur & Hayward, 1997)

• Greater levels of stress (Chang, Watkins, & Banks, 2004)

• Improved emotional regulating strategies (Aldea & Rice, 2006)

• Increased feelings of inferiority (Ashby & Kottman, 1996)

• Greater sense of general self-efficacy (LoCicero & Ashby, 2000)

• Decreased self esteem and confidence (Ashby & Rice, 2002)

• Increased self esteem (Ashby & Rice, 2002)

• Increased levels of depression (Rice & Mirzadeh, 2000)

• Suicide ideation (O�Connor & Forgan, 2007)

• Increased positive affect and overall psychological wellbeing (Frost, Heimberg, Holt, Mattia, & Neubauer, 1993; Rice & Slaney, 2002)

• Constant negative evaluations of one�s performance (Rice et al., 1998)

• Ability to be satisfied with one�s performance (Enns et al., 2002)

• Excessive concern over mistakes (Rice & Ashby, 2007)

• Fear of failure (Conroy, Kay, & Fifer, 2007)

• Greater acceptance of an imperfect outcome (Lundh, 2004)

• Higher external locus of control (Periasamy & Ashby, 2002)

• Higher internal locus of control (Periasamy & Ashby, 2002)

• Little or no academic advantages (Rice & Mirzadeh, 2000)

• Increased procrastination (Rice et al., 1998)

• Positive academic achievement (Enns, Cox, Sareen, & Freeman, 2001)

• Conscientiousness (Parker, 1997)

• Poor coping skills (Blankstein & Lumley, 2008)

• More positive coping skills (Blankstein & Lumley, 2008)

• Insecure adult relationships (Rice, Lopez, & Vergara, 2005)

• More secure adult relationships (Rice, Lopez, & Vergara, 2005)

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WHY BE CONCERNED ABOUT PERFECTIONISM?

E T I O L O G Y : 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.

S O C I E T A L I N F L U E N C E : 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 O M O R B I D I T Y : 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 R E AT M E N T I N T E R F E R E N C E :

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).

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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�.

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?

P E R F E C T I O N I S M / A C C E P T A N C E T H E O R Y - � H I G H P E R S O N A L S T A N D A R D S O R O T H E R S T R I V I N G S F O R P E R F E C T I O N A R E A D A P T I V E W H E N C O M B I N E D W I T H T H E A C C E P T A N C E O F N O N - P E R F E C T I O N ( I . E . , T H E A C C E P T A N C E O F V A R I O U S K I N D S O F F A I L U R E S , M I S T A K E S , A N D S H O R T C O M I N G S ) , B U T M A L A D A P T I V E W H E N C O M B I N E D W I T H A N I N A B I L I T Y T O A C C E P T F A I L U R E S , M I S T A K E S , A N D S H O R T C O M I N G S �

( L U N D H , S A B O O N C H I , & W Å N G B Y , 2 0 0 8 , P . 3 3 5 )

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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 E D I C A L M O D E L V E R S U S P O S I T I V E P S Y C H O L O G Y : 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 O G N I T I V E -B E H A V I O U R A L I N T E R V E N T I O N S : 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.

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P O S I T I V E P S Y C H O L O G Y I N T E R V E N T I O N S : The intent of the positive psychological approach is not necessarily to usurp the approach of the medical model or dismiss the pre-existing 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.

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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)

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.

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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.

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VIGNETTE QUESTIONS FOR CONSIDER ATI ON:

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, self-

oriented, 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)?

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RESOURCES AND FURTHER INFORMATION

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).

Lopez, S. J., & Snyder, C. R. (Eds.). (2003). Positive psychological assessment: A handbook of models and measures. Washington, DC: American Psychological Association. 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 R O U P T R E A T M E N T F O R P E R F E C T I O N I S M: 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, 134-150.

T R E AT I N G P E R F E C T I O N I S M I N C H I L D R E N: 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: http://library.athabascau.ca/drr/viewdtr.php?course=DTPR&id=352

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Development, 74, 393-398.

Slaney, R. B., Mobley, M., Trippi, J., Ashby, J. S., & Johnson, D. (1996). Almost Perfect Scale-Revised,

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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, 130-145. 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. 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)

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.

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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. 1 2 3 4 5 6 7 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.

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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 30-45 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: http://www.authentichappiness.sas.upenn.edu (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 email 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.

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Screen Shot 1

Screen Shot 2

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Classification of 6 Virtues and 24 Character Strengths

Virtue & Strength Definition

1. Wisdom and

Knowledge

Cognitive strengths that entail the acquisition and use of knowledge

Creativity Thinking of novel and productive ways to do things

Curiosity Taking an interest in all of ongoing experience

Open-mindedness Thinking things through and examining them from all sides

Love of learning Mastering new skills, topics, and bodies of knowledge

Perspective Being able to provide wise counsel to others

2. Courage

Emotional strengths that involve the exercise of will to accomplish goals in the face of opposition, external or internal

Authenticity Speaking the truth and presenting oneself in a genuine way

Bravery Not shrinking from threat, challenge, difficulty, or pain

Persistence Finishing what one starts

Zest Approaching life with excitement and energy

3. Humanity

Interpersonal strengths that involve �tending and befriending� others

Kindness Doing favors and good deeds for others

Love Valuing close relations with others

Social intelligence Being aware of the motives and feelings of self and others

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4. Justice

Civic strengths that underlie healthy community life

Fairness Treating all people the same according to notions of fairness and justice

Leadership Organizing group activities and seeing that they happen

Teamwork Working well as member of a group or team

5. Temperance

Strengths that protect against excess

Forgiveness Forgiving those who have done wrong

Modesty Letting one�s accomplishments speak for themselves

Prudence Being careful about one�s choices; not saying or doing things that might later be regretted

Self-regulation Regulating what one feels and does

6. Transcendence

Strengths that forge connections to the larger universe and provide meaning

Appreciation of beauty and excellence

Noticing and appreciating beauty, excellence, and/or skilled performance in all domains of life

Gratitude Being aware of and thankful for the good things that happen

Hope Expecting the best and working to achieve it

Humor Liking to laugh and tease; bringing smiles to other people

Religiousness Having coherent beliefs about the higher purpose and meaning of life

Note. From �Positive Psychology Progress: Empirical Validation of Interventions� by M.E.P. Seligman, T.A. Steen, N. Park, and C. Peterson, 2005, American Psychologist, 60, p. 412. Copyright © 2005 by the American Psychological Association. Reprinted with permission.

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CHAPTER IV: SYNTHESIS AND IMPLICATIONS

The aim of this final project was to examine the conceptualization of perfectionism and

elucidate corresponding treatment strategies embedded in a positive psychological approach.

This was accomplished through a literature review and the subsequent compilation of a

guidebook for counsellors. The literature review focused on the shift from conceptualizing

perfectionism as a unidimensional construct to a multidimensional construct and the associated

implications for measurement and treatment. The distinguishing aspect of this project was the

parallel that was drawn between the multidimensional view of perfectionism and the positive

psychology paradigm. This corresponds with the notion that if perfectionism does in fact contain

adaptive and potentially enhancing factors, the infusion of a strength-based positive

psychological approach has the potential to provide the most comprehensive treatment

interventions for perfectionistic clients.

The creation of the guidebook as the applied element of this project encompasses the

main topics from the literature review, presenting them in a �counsellor-friendly� format. Key

information is provided on perfectionism conceptualization and treatment, positive psychology,

as well as several practical tools and ideas for working with perfectionistic clients. The

guidebook is intended to be capable of serving as a standalone document for counsellors to use in

their work with clients. It also provides suggested references for counsellors to access to increase

their repertoire of skills for counseling clients with perfectionism. The scope of the literature

review and guidebook is limited to a focus on individual adult counselling clientele, although

references are provided for other populations and treatment modalities.

Given the focus of the guidebook, it would be useful in a number of different counselling

settings. University and college counselling departments would be an important venue,

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particularly considering the manner in which perfectionism can dramatically interfere with

academic achievement (Kutlesa & Arthur, 2008). Additionally, counsellors at community

agencies and health centers could benefit from this guidebook, as the pervasiveness of

perfectionism is vast and its links to other mental health conditions assures that a wide range of

clientele are afflicted.

Overall, this guidebook was created in response to research suggesting a) perfectionism

is a pervasive concern that is linked to numerous other counselling issues (Rudolph et al., 2007)

and is sometimes overlooked in the counselling milieu, b) treating this elaborate construct

requires a complex treatment approach (Flett & Hewitt, 2004), and, c) the burgeoning field of

positive psychology holds great promise in applied treatment approaches (Foster & Lloyd, 2007).

Additionally, this writer was unable to locate any resources that examined the treatment of

perfectionism through the paradigm of positive psychology. Taken together, these factors

provided the impetus for the creation of this applied project. It is hoped that this resource will

alert counsellors to the impact of perfectionism and reinforce the need to address this construct

more regularly in the counselling environment, as well as assist counsellors in developing more

skills for assessing and treating perfectionism in their clients.

Project Implications

The potentially valuable implications of this project are far-reaching in three areas: First,

by way of advancing conceptual clarity, second, by drawing attention to the importance of a

positive psychological approach, and third, by strengthening the link from theory to practice

through establishing a more tangible set of counselling recommendations in the guidebook.

The first valuable implication of this project is the clarification of some of the ambiguous

and conflicting conceptualizations of perfectionism. Given the number of conceptual shifts

34

surrounding perfectionism, it was beneficial to provide a sense of unity in a common

understanding of where the research presently stands. This will assist counsellors to reinforce

and extend their own understanding of this complex construct. By extension, counsellors�

increased understanding of perfectionism will hopefully translate into better psychoeducation

and treatment interventions for their clients.

The second beneficial implication of this project is the integration of a positive

psychological approach to the treatment of perfectionism. The field of positive psychology has

grown exponentially and research has pointed to the efficacy of augmenting existing treatment

practices with a strength-based approach (e.g., Harris et al., 2007), which allows for a more

holistic treatment strategy. In addition to the implication of bringing awareness to the overall

conceptualization of perfectionism, it is also the intention of this project to bring attention to the

positive psychological treatment approach. The value of this guidebook goes beyond a simple set

of counselling recommendations for working with perfectionistic clients. Its utility in fostering a

counselling milieu that is rooted in a strength-based orientation has the potential to cultivate

clients� resiliency and self-development in numerous ways that even extend beyond

perfectionism itself.

The third implication of this project is to provide counsellors with interventions and

counselling techniques to work with clients who are struggling with perfectionism. Given the

pervasive nature of perfectionism and its implication in countless cases of psychopathology, it is

undoubtedly useful to both counsellors and clients to determine some of the best approaches for

working with these issues. A related implication is the awareness brought forth in the guidebook

concerning the issue of comorbidity. Perfectionism has its own unique set of treatment concerns

because clients rarely seek counselling to address their perfectionistic tendencies per se; rather it

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is another condition that is somehow associated or linked to the client�s perfectionism. The

guidebook points out multiple conditions and client issues that have been associated with both

maladaptive and adaptive perfectionism. It is hoped this information will help counsellors

become more informed and discerning in identifying a client�s counselling issues and more

responsive to the need to screen for perfectionism when a client presents with other issues.

Project Limitations

There are a few noteworthy limitations to consider when analyzing the overall utility of

this guidebook. First, it is important to acknowledge the tremendous paucity of research that

exists in identifying empirically validated treatment methodologies for perfectionism (Flett &

Hewitt, 2007), moreover, positive psychological treatment approaches also experience a dearth

of evidence-based support (Harris et al., 2007). Consequently, the application of positive

psychology treatment practices to the construct of perfectionism does not yet have the support to

be recognized as an evidence-based practice in the field. Although this writer was able to

compose a strong argument for the value and efficacy of an approach that integrates positive

psychology into the treatment of perfectionism, future research to assess the validity of this type

of intervention would be a valuable contribution to the field.

Another limitation of this project is the unmistakable western European bias that is

present throughout both the literature review and the guidebook. This project does not address

the cultural factors related to one�s experience of perfectionism and also does not focus on

incorporating multiculturalism into its assessment and intervention practices. The present state of

the research on perfectionism presented a significant barrier to integrating a multicultural

element within this project. As mentioned by Chang et al. (2004), the generalizability of

perfectionism theory and research to diverse racial groups is unknown because the majority of

36

study participants are Caucasian. It appears that although some researchers have made brief

mention of the importance of culture in understanding perfectionism (e.g., Bieling et al., 2004)

the consideration of the cultural context of perfectionism has been given limited attention.

Overall, it is highly recommended that future research in the area of perfectionism examines

culture in regard to the conceptualization, assessment, and treatment practices of this construct.

Future Research Directions

Although there has been a significant proliferation of research in the area of

perfectionism, it is evident that certain deficiencies in the literature still exist. In addition to the

areas evidence-based treatment practices and cultural considerations that were mentioned in the

limitations of this project, there are some further areas for consideration.

The body of research on perfectionism is still in dire need of clarification on many fronts.

The numerous conflicting results that continue to plague the field are undoubtedly hindering the

growth and development of research because it is difficult to build upon an uneven foundation. It

is essential that researchers attempt to remedy this issue by clarify such issues as: �What really is

adaptive about perfectionism?�, �Is it more beneficial to be an adaptive perfectionist or a non-

perfectionist?�, �What exactly is the relationship between maladaptive and adaptive

perfectionism?�, and, �Does the presence of adaptive perfectionism put an individual at risk for

maladaptive perfectionism?� The answers to these questions will be instrumental in providing

more structure and direction for perfectionism research.

An additional recommendation by Bieling et al. (2003) points out that in order to

understand perfectionism more thoroughly researchers need to examine this construct

longitudinally. Some studies have conducted follow-up measures that assess perfectionism in the

study�s participants a second time (e.g., Enns et al., 2001), but this is usually within a limited

37

timeframe (i.e., 6 months) and does not reflect a true longitudinal study. It would be extremely

useful for researchers to identify and assess perfectionistic children and follow the ongoing

progression of their perfectionism throughout their development. This would provide a more

comprehensive understanding of perfectionism and potentially shed further light on the etiology

of this construct. Moreover, this type of approach would assist in the development of prevention

and early intervention strategies that could target perfectionism at an early age to avoid the

advancement of factors that could eventually transform into maladaptive perfectionism.

Conclusion

Despite the fact that several areas of perfectionism research are plagued with

inconsistencies and thus remain inconclusive, it is hoped that this project raises awareness of

how far the field has evolved in conceptualizing perfectionism. From the unidimensional

perspective to the present multidimensional perspective, our broadened understanding of

perfectionism has brought about further opportunities for treatment strategies. This project

provides a starting place for thinking about the treatment of perfectionism from a positive

psychological orientation and it is anticipated that the amalgamation of these two domains of

psychology will instill a sense of optimism in developing more strength-based interventions.

Overall, it is hoped that this resource increases awareness of perfectionism among counsellors to

bring about a deeper understanding of this enigmatic construct, and will further translate into

more effective treatment practices.

38

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