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Porcelain Dolls Dr. Carly LeBaron, LMFT

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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!)

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