Are Perfectionist Therapists Perfect? Addressing Therapist Schemas in CBT

Research has largely focussed on establishing how client perfectionism relates to psychopathology, how it may impede outcomes in
cognitive-behavioural therapy (CBT) and how it might be understood and treated. Less attention has been given to how therapist
perfectionism may impact upon the therapeutic process within CBT treatment. The importance of therapists reflecting upon their own
schema has featured little in the CBT literature until more recently (Haarhoff, 2006), with the emphasis traditionally being on
implementing model-driven interventions (Leahy, 2008). Recent work has given more attention to the benefits of therapists reflecting
upon the potential impact of their own schema upon their therapeutic work (Leahy 2001; Young, Klosko and Weishar, 2003; Haarhoff,
2006) and the use of supervision, self-reflection and self-practice is now being more strongly encouraged (Bennet-Levy, 2006; Pretorius,
2006). Perfectionism has been identified as a common therapist schema, with Haarhoff (2006) finding rates of 75-87% amongst trainee
CBT therapists. Whilst multidimensional explanations of perfectionism acknowledge adaptive components of the construct which may
enhance therapist effectiveness (e.g. organisation, positive striving for achievement, orderliness), the potential detrimental effect of more
maladaptive components remains. Indeed, a recent study found a number of significant negative associations were observed between
aspects of therapist perfectionism, treatment efficacy and client retention in treatment (Presley, Jones and Newton, 2017). More
specifically, therapist factors such as having high standards for others, striving for excellence, being concerned about making mistakes,
rumination and planfulness were all associated with lesser treatment outcomes for depression and/or anxiety disorders. This skills class
therefore provides an opportunity for participants to consider how and why these therapist factors might impede CBT treatment, consider
how such effects might be reduced, and reflect on any personal challenges/changes related to this.
The skills class aims to:
1. To consider both client and therapist factors which contribute to therapeutic relationships and outcomes in psychotherapy
2. To reflect upon the impact of our own schema on our work with our clients
3. To consider the impact of therapist perfectionism specifically
4. To discuss and interpret research outcomes in this area
5. To consider ways in which we can manage and minimise any detrimental effect of our schema on our therapeutic work with clients
References:
Haarhoff, B. A. (2006) The Importance of Identifying Therapist Schema in Cognitive Therapy Training and Supervision. New Zealand Journal
of Psychology, 35 (3): 126-131.
Presley, V. L., Jones, C. A., & Newton, E. K. (2017). Are Perfectionist Therapists Perfect? The Relationship between Therapist Perfectionism
and Client Outcomes in Cognitive Behavioural Therapy. Behavioural and Cognitive Psychotherapy , 45 (3): 225-237.