PORCELAIN DOLLSA Cognitive-Behavioral Approach to Breaking Through Perfectionism and People-Pleasing In Women

Dr. Carly LeBaron, LMFT

PRESENTATION OUTLINE

What is a Porcelain Doll?

PerfectionismDefinitionHow it presents

People-PleasingDefinitionHow it presents

Contributing Gender IssuesSocializationCultural roles, rules, & expectations

Compassionate CBT Treatment Approach

PORCELAIN DOLLS

What do they look like?Demographics

What do they do?Common behavioral signs

What are their presenting problems?Depression, anxiety, EDs, low self-esteem, body image issues, etc.

Don’t get taken in by them!They will very frequently be some of your favorite clients (even though we don’t play favorites,

right?). Why?

PERFECTIONISM

DefinitionSetting excessively, sometimes impossibly, high performance standards accompanied by

overly critical self-evaluations and fears of others’ evaluations of them.

How it ManifestsHigh functioning perfectionists

Strong achievement orientationHighly Successful (straight A’s, scholarships, rapid job promotions)Pedestals, golden children

Low functioning perfectionistsLack of follow-throughFailing out of schoolQuitting before completionLosing jobs

The Core of PerfectionismIf people see who I really am, how flawed I really am, they will reject me and/or abandon me.

PERFECTIONISM

The Benefits of PerfectionismGet things doneLots of praise/reinforcementAchievementsProtection from being real

The Costs of PerfectionismParalysisExhaustionNever feeling good enoughRide the high of one achievement, but it never lastsConstantly seeking external sources of self-esteem

PERFECTIONISM

Why is perfectionism so difficult to treat and hard to beat?

Reinforced in our culture (capitalism, individualism)

Friends, family members, professors, church leadersPerfectionists serve a purpose for the rest of us

LDS contextBe ye therefore perfect…

People love a perfectionistWhy?

PEOPLE-PLEASING

DefinitionAn intense focus on behaving only in ways that please others, regardless of personal

wants/needs/opinions/thoughts and an overwhelming concern with how others perceive you.

How it ManifestsThe Yes WomanDon’t rock the boatUndifferentiatedDon’t get angryAlways be nice!!!!!!!!!!!!!! (Did I put enough exclamation points?!...)Oh, yeah, and always checking to see if what they say/think/feel is okay

The Core of People-PleasingI have to go out of my way to please people or they won’t like meI have nothing else to offer but to please others, so if I don’t please them, they won’t accept

me

PEOPLE-PLEASING

The Benefits of People-PleasingOthers respond positively to youYou make people happyYou avoid confrontationYou avoid hurting people’s feelings

The Costs of People-PleasingYour needs get ignoredYou can become a doormatYou develop resentmentTend towards passive-aggressive to get needs metWhen people refuse to be pleased, it must be your faultPeople lose respect for youYou sacrifice self growth and genuine relationships

PEOPLE-PLEASING

Why is it so difficult to treat and hard to beat?

Reinforced by conservative, traditional cultures

Reinforced by most people in our clients’ lives and our own livesPeople like it when they get what they want and people-pleasers deliver!

People pleasers are convinced that to do things any other way would be “mean,” “creating contention,” or “un-Christlike.”

Counteracting years of gender socialization

GENDER ISSUES

Women as relationship monitors

Women garner their self-esteem from success in relationshipsSuccess in relational roles

Socialized to be more attuned to social cues, social control, especially from other women

Relational aggressionMean girls, Queen Bees and Wannabes

Comparison (upward and downward)

What else can you think of?

GENDER ISSUES

GIRL RULES:Be Nice!Don’t call attention to yourself.Put others needs first.You can do better than that.Indirect queries to get needs met

Manipulation, subversive

Mind-readingEmphasis on looks, image

Other rules you can think of?Both implicit and explicit rules

SELF-OF-THE-THERAPIST

Why do I love working with this population so much?

Mary PoppinsMy externalization

Once a compliment, now an insult

What about you?Self-check

PerfectionismPeople-pleasing

TREATMENT APPROACH

Cognitive process

EVENT EVENT EVENT EVENT EVENT

MENTAL ILLNESS FILTER (DEPRESSION, ANXIETY, OCD, EATING DISORDER, etc.)

POSITIVE CORE

BELIEFS

NEGATIVE CORE

BELIEFS

FEELINGS

TREATMENT APPROACH

Core BeliefsPositive and NegativeOkay to have both, need balanceMessages from FoO, other memorable instances

Cognitive Distortions (Burns, Feeling Good)AoNTOvMFDtPJtC

MR, FT

M&MERSSL&MPe

TREATMENT APPROACH

Fight back against CDsReality Checking (All)

“Is that really true?”

Living in the Gray (AoNT)Empowerment (O)The Lawyer Technique (MF)Reinforce PCBs (DP)10 Possible Alternatives (JtC)Apples to Apples, Oranges to Oranges (M&M-Comp)Relaxing Rigidity (SS)The Confessional (ER)Would a Teenage Girl Say This? (L&M)I Have the Power! (P)

TREATMENT APPROACH

STOP, It’s Narrative Time!The importance of EXTERNALIZING

The Mask Activity

What Perfect Looks Like/Feels Like, What Real Looks Like/Feels Like

TREATMENT APPROACH

Practicing Imperfection (aka Deperfectifying)Start with little things:

Spill on purpose, don’t clean it up for 10 minutesPaint every fingernail but oneQ-tip example

Move on to bigger thingsBe late to a lunch date with a friendDeliberately flub a few words during a presentation or while talking to coworkersDon’t wear makeup for a whole day out

Dare to be Average and the Mediocre Bucket ListForget the 5- and 10-year plans, let’s get mediocre!

The Velveteen RabbitEncourage them to read it. Just do it. You’ll thank me later.

TREATMENT APPROACHAssertiveness TrainingStep 1: Convince her that assertiveness=/= being mean

Teach difference between passive, assertive, and aggressive

Step 2: Repeat step one until you are blue in the faceStep 3: Practice real life situations with her using role plays

Switch roles so she learns to be both voices

Step 4: Give her homework to practice in real life

Learning to say “No”“Let me check my schedule…”

The BacklashSome people will NOT respond well to your client’s changesPrepare her in advanceShe will feel mean initially, validate her

Others may even tell her she is being mean, process that

Remind them: “That’s more about them than it is about you.”Authority figures will be the most difficult to be assertive with

TREATMENT APPROACH

Self-Compassion and Self-ForgivenessThe crux of successful treatment with this populationSpend lots of time hereModel self-compassion, self-disclosureThe Best Friend TechniqueThe Internal Cheerleader (or Therapist)

WWCS?Permission to temporarily internalize my voice until it can become their own

Forgiveness is a process“Will the world end/anything spontaneously combust if I do X?”“Will this matter in a year? 6 months? 2 Months? Next week? Tomorrow?”

Only give it as much power as it deserves

TREATMENT APPROACH

HomeworkLet’s talk about strategery…

The cool part about every homework you EVER give a perfectionist: THEY CAN’T FAIL!!!...or is that bad?

Imperfect practice makes imperfect!

Test the watersBe ready for them to come back unhappy, in pain, scaredProvide support and encouragement

Allow them to be imperfect with you

Catch them in people-pleasing with youGive them permission to disagree, be angry, etc.

Carly Voodoo Doll

QUESTIONS OR COMMENTS

Contact Information:

Dr. Carly LeBaron, LMFT

Utah Valley Counseling

2230 N. University Parkway,

Suite 11D, Provo, UT

(801) 407-4134

carlylebaron@utahvalleycounseling.com

(Feel free to grab one of my cards with my contact info!)