Porcelain Dolls

1. Porcelain Dolls A Cognitive-Behavioral Approach to Breaking Through Perfectionism and People-Pleasing In Women Dr. Carly LeBaron, LMFT

2. Presentation outline • What is a Porcelain Doll? • Perfectionism • Definition • How it presents • People-Pleasing • Definition • How it presents • Contributing Gender Issues • Socialization • Cultural roles, rules, & expectations • Compassionate CBT Treatment Approach

3. 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?

4. perfectionism • Definition • Setting excessively, sometimes impossibly, high performance standards accompanied by overly critical self-evaluations and fears of others’ evaluations of them. • How it Manifests • High functioning perfectionists • Strong achievement orientation • Highly Successful (straight A’s, scholarships, rapid job promotions) • Pedestals, golden children • Low functioning perfectionists • Lack of follow-through • Failing out of school • Quitting before completion • Losing jobs • The Core of Perfectionism • If people see who I really am, how flawed I really am, they will reject me and/or abandon me.

5. Perfectionism • The Benefits of Perfectionism • Get things done • Lots of praise/reinforcement • Achievements • Protection from being real • The Costs of Perfectionism • Paralysis • Exhaustion • Never feeling good enough • Ride the high of one achievement, but it never lasts • Constantly seeking external sources of self-esteem

6. perfectionism • Why is perfectionism so difficult to treat and hard to beat? • Reinforced in our culture (capitalism, individualism) • Friends, family members, professors, church leaders • Perfectionists serve a purpose for the rest of us • LDS context • Be ye therefore perfect… • People love a perfectionist • Why?

7. People-pleasing • Definition • An 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 Manifests • The Yes Woman • Don’t rock the boat • Undifferentiated • Don’t get angry • Always 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-Pleasing • I have to go out of my way to please people or they won’t like me • I have nothing else to offer but to please others, so if I don’t please them, they won’t accept me

8. People-pleasing • The Benefits of People-Pleasing • Others respond positively to you • You make people happy • You avoid confrontation • You avoid hurting people’s feelings • The Costs of People-Pleasing • Your needs get ignored • You can become a doormat • You develop resentment • Tend towards passive-aggressive to get needs met • When people refuse to be pleased, it must be your fault • People lose respect for you • You sacrifice self growth and genuine relationships

9. 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 lives • People 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

10. Gender issues • Women as relationship monitors • Women garner their self-esteem from success in relationships • Success in relational roles • Socialized to be more attuned to social cues, social control, especially from other women • Relational aggression • Mean girls, Queen Bees and Wannabes • Comparison (upward and downward) • What else can you think of?

11. 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-reading • Emphasis on looks, image • Other rules you can think of? • Both implicit and explicit rules

12. Self-of-the-therapist • Why do I love working with this population so much? • Mary Poppins • My externalization • Once a compliment, now an insult • What about you? • Self-check • Perfectionism • People-pleasing

13. Treatment approach • Cognitive process

14. Treatment approach • Core Beliefs • Positive and Negative • Okay to have both, need balance • Messages from FoO, other memorable instances • Cognitive Distortions (Burns, Feeling Good) • AoNT • Ov • MF • DtP • JtC • MR, FT • M&M • ER • SS • L&M • Pe

15. Treatment approach • Fight back against CDs • Reality 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)

16. 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

17. Treatment approach • Practicing Imperfection (aka Deperfectifying) • Start with little things: • Spill on purpose, don’t clean it up for 10 minutes • Paint every fingernail but one • Q-tip example • Move on to bigger things • Be late to a lunch date with a friend • Deliberately flub a few words during a presentation or while talking to coworkers • Don’t wear makeup for a whole day out • Dare to be Averageand the Mediocre Bucket List • Forget the 5- and 10-year plans, let’s get mediocre! • The Velveteen Rabbit • Encourage them to read it. Just do it. You’ll thank me later.

18. Treatment approach • Assertiveness Training • Step 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 face • Step 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 Backlash • Some people will NOT respond well to your client’s changes • Prepare her in advance • She 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

19. Treatment approach • Self-Compassion and Self-Forgiveness • The crux of successful treatment with this population • Spend lots of time here • Model self-compassion, self-disclosure • The Best Friend Technique • The 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

20. Treatment approach • Homework • Let’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 waters • Be ready for them to come back unhappy, in pain, scared • Provide support and encouragement • Allow them to be imperfect with you • Catch them in people-pleasing with you • Give them permission to disagree, be angry, etc. • Carly Voodoo Doll

21. 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!)