Client perfectionism and psychological symptoms throughout psychotherapy

Objective: Given the psychological issues experienced by individuals high in perfectionistic concerns (maladaptive perfectionism), or a feeling as if one is never good enough, and discrepancies in the literature as to whether these individuals experience benefits from therapy, it is imperative that research examine whether perfectionism actually improves throughout therapy. The current study improves upon past research by examining changes in perfectionism (both perfectionistic concerns and strivings) throughout therapy, rather than simply measuring perfectionism at pre- and post-therapy. This study also investigates how these changes in perfectionism, if they exist, impact changes in psychological symptoms. Methods: In total, 153 clients at a psychology training clinic in which a general treatment paradigm was implemented completed the Short Almost Perfect Scale (SAPS; Rice et al., 2014) and Outcome Questionnaire (OQ-45.2; Lambert et al., 1996) prior to intake and sessions 1, 3, and 5. Results and Conclusions: Multilevel modeling results revealed that there were significant improvements in perfectionistic concerns and symptoms although, as expected, no significant changes in perfectionistic strivings were observed. Additionally, there was a trend effect for changes in perfectionistic concerns being associated with changes in symptoms. Further, results of latent difference score analyses revealed that changes in symptoms throughout therapy preceded changes in perfectionistic concerns. Clinical and methodological significance of this article: This study uses multilevel modeling (MLM) and latent difference score analyses to assess changes in perfectionism throughout therapy, whether they are associated with changes in symptoms, and whether changes in perfectionism precede changes in symptoms, or vice versa. To date, there have been discrepancies in the literature as to whether perfectionism improves throughout therapy, and most of these have only measured perfectionism at pre- and post-therapy. This study is an improvement over past studies as it measures perfectionism throughout therapy which has implications for therapy work with perfectionistic clients.