“How do you conceptualize perfectionism within ISTDP? As a character defense? As a form of supergo pathology? And how would you deal with it? ” Thanks to Matthew for this question.
If we start with the triangle of conflict (feeling, anxiety, and defense), it is clear that perfectionism is neither a feeling nor anxiety but a defense. How do we understand that defense? One way is as a character defense.
As you remember, with a character defense the patient does to himself what someone did to him in the past. Thus, if the patient had a perfectionistic, critical father, he may criticize himself and hold himself up to perfectionistic standards. That is, rather than feel rage toward his critical father, as a defense he identifies with the father toward whom he felt rage. “Oh no, I don’t feel rage toward him. I am him.” As the psychoanalytic literature shows, the patient may identify with the critical parent to avoid loss, to ward off anger, and to maintain an insecure attachment. Thus, as Lorna Benjamin so beautifully says, the defense is a “gift of love.” “I love my father so much that I will protect him and our relationship from my anger by turning it on myself in the form of self-criticism and perfectionism.
As a character defense then, yes, perfectionism is part of superego pathology. The superego, according to Klein, Kernberg, and others, is comprised of a series of pathological introjects. Yes, I will translate. It means the superego is comprised of a group of painful memories of relationships. These memories are organized as a picture of yourself (self representation), a picture of the other person (object representation), and the affect linking the two pictures. These unconscious memories are enacted in therapy in three ways: 1) character defense: I criticize myself the way my father criticized me; 2) transference resistance: I criticize you the way my father criticized me; and 3) projection of the superego: I fear you will criticize me the way my father did.
When addressing a character defense, we must address the structure of the defense, i.e., the way the patient relates to himself. “Do you notice how you attack yourself?” “Do you notice how you verbally abuse yourself?” Once you do this phase of defense identification, we can clarify the defense: “Could this self-attack be hurting you and making you depressed?” This clarifies the price of the defense. Then you can clarify the function: “I notice you criticize yourself now after you criticized me. Could this be a way you protect me from your criticism?”
When talking about perfectionism, however, we should take a little detour into theory. The perfectionistic person believes he should be the same as his ideal, what psychoanalysts call the ‘ego ideal.’ Our ideals are important. They give meaning and direction to our lives. But we will never be the same as our ideals, being the mere mortal human beings that we are. An ideal is like the North Star. You can rely on the North Star to steer your boat, but no matter how far you sail, you will never end up on the North Star!
The perfectionistic person misuses his ideals for the purpose of self- torture. He believes he should be the same as his ideal rather than someone who will always be oriented toward the ideal. This is often an identification with the critical parent: “Don’t be the way you are my son! Be the way I want you to be (ideal)!” “I can’t love you, but I could love this picture I have in my head.” The son who identifies with such a critical father will reject himself as his father did, believing he should be ideal instead. He rejects his essence, embracing his ideal instead.
Never argue with the content of his perfectionism. Instead, focus on the way he relates to himself, how he is vicious to himself, how he rejects himself, and how he attacks himself.
However, like all defenses, perfectionism can emerge in other forms as well. For instance, a perfectionistic person may reject whatever you say as “not quite good enough.” Here, he rejects you as he was rejected; he becomes the perfectionistic father to you as the never quite good enough child/therapist. In this case, we have to help the patient see how his perfectionism creates a wall between him and you and between him and other people. Rather than get entangled in the content his criticisms, always note their defensive function. “You said it was not a good enough question, but you didn’t answer it. If you don’t dismiss the question, what is the feeling here toward me?” This would be an example of defense identification. Here’s another: “Do you notice you want to argue rather than say what you feel here toward me?” Here would be an example of identifying the transference resistance: “Do you notice how these criticisms come up here between us as a kind of wall separating us?”
Of course, we therapists can, and often are, wrong. So patient criticisms can be very much on target. So we must not dismiss a patient’s criticism as defensive perfectionism when we are uncomfortable being on the receiving end of criticism.
In the cases we are looking at here, the patient is either perfectionistic with himself or with others. “I don’t have a superego; I am one!!” For instance, the man who is perfectionistic with you may very well be perfectionistic with his wife, criticizing her weight, her dress, her cooking, or her love making. He becomes tyrannically controlling with her to avoid the inner tyranny of his own self-criticism and perfectionism.
But, there is another solution. Pretend to be perfect! In this manic solution, I don’t suffer from not being the same as my ideals. I claim to be the same as them! But for this to work, it helps to have a cult of acolytes around to keep that myth of perfection aliveJ This is the sort of perfectionist who will probably criticize his wife, as we saw above.
Take home point: perfectionism is a form of superego pathology. It can take the form of a character defense, a transference resistance, or projection of the superego. The patient can also take a manic solution of claiming to be the same as his ideal. The most important thing to remember about perfectionism is that it is fundamentally a form of self-hatred. The perfectionistic patient believes he cannot be loved for his essence, only if he becomes the same as an ideal. He believes he is not unconditionally loveable for who he is; he believes he can be loved only conditionally, based on what he does. Perfectionism, in it’s neurotic form, is the love of the perfect and the hatred of the person. Maybe we should strive for the higher perfection: being perfectly imperfectJ
For more information on superego pathology, check out the chapter on superego pathology in Co-Creating Change: Effective Dynamic Therapy Techniques http://www.istdpinstitute.com/co-creating-change/