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

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

3. Porcelain dolls What do they look like? What do they do?
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 How it Manifests The Core of Perfectionism
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 The Costs 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 How it Manifests
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: Other rules you can think of? 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 Mask Activity
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 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.

18. Treatment approach Assertiveness Training Learning to say “No”
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 Imperfect practice makes imperfect!
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)
(Feel free to grab one of my cards with my contact info!)