Transcript Porcelain Dolls

PORCELAIN DOLLS
A Cognitive-Behavioral Approach to Breaking
Through Perfectionism and People-Pleasing
In Women
Dr. Carly LeBaron, LMFT
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
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
Definition
Setting excessively, sometimes impossibly, high performance standards accompanied by overly critical selfevaluations 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.
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
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?
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
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
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
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?
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
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
TREATMENT APPROACH
EVENT
EVENT
Cognitive process
EVENT
EVENT
EVENT
MENTAL ILLNESS FILTER (DEPRESSION, ANXIETY, OCD, EATING DISORDER, etc.)
NEGATIVE
CORE
BELIEFS
POSITIVE
CORE
BELIEFS
FEELINGS
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
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)
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 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 Average and 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.
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
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
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
QUESTIONS OR COMMENTS
Contact Information:
Dr. Carly LeBaron, LMFT
Utah Valley Counseling
2230 N. University Parkway,
Suite 11D, Provo, UT
(801) 407-4134
[email protected]
(Feel free to grab one of my cards with my contact info!)