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The impact of protective perfectionistic self-presentation on group psychotherapy process and outcome Flynn, Carol Ann


Recent studies reported that perfectionism was linked to negative outcome for all interventions in the NIMH Treatment of Depression Collaborative Research Program. Specifically, perfectionism impeded progress following the eighth session of psychotherapy. The present study investigated the impact of perfectionistic self-presentation (the need to appear to be perfect) on members' experience of a short-term interpersonal therapy group. Individuals who score highly on protective forms of perfectionistic self-presentation avoid being seen as imperfect or foolish and avoid admitting to any mistakes or shortcomings. Therefore, it was anticipated that protective forms of perfectionistic self-presentation would be associated with greater therapy-related stress as assessed by self-report of anxiety, salivary Cortisol levels (a physiological indicator of stress), and behavioural indicators such as tardiness, missed sessions, and lack of self-disclosure during therapy. In addition, a mediational model was proposed in which protective forms of perfectionistic self-presentation may lead to discomfort during the process of therapy, which, in turn, results in poor therapy outcome. Therapy outcome was evaluated using measures of trait perfectionism, psychological symptomatology, stress reactivity, and ratings of benefit by group members, therapists, and friends or family members of each group member. Results tended to support initial hypotheses, as well as past research findings suggesting that perfectionists experience greater difficulties later in the course of therapy. In particular, concerns about disclosing imperfections were associated with increased post-session anxiety late in therapy, missing sessions without calling to provide an excuse, and for women, a relative decrease in disclosure over the course of therapy compared to other participants. Nondisclosure of imperfections also predicted less improvement in depression scores and skin conductance stress reactivity following treatment. Finally, the impact of nondisclosure of imperfections on negative therapy outcome was partially mediated by elevated anxiety late in therapy, and for women, lack of increase in disclosure over the course of therapy. Thus, this study provides evidence of the adverse impact of perfectionistic self-presentation on clients' affect and engagement within the therapy context, suggesting two mechanisms that may lead perfectionists to experience poor therapy outcome.

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