Practise makes perfect, but do you really want a perfect practice?


Running an independent psychotherapy practice is an exercise in developing humility. How many times each week do you shift uncomfortably in your chair as you listen to a client describing their thoughts and feelings, and reflect that at least some of what they are describing is true of you too?
Depressed? Maybe. Anxious? Perhaps. Family relationships not quite as stable or nurturing as you might hope? Hmmmm.
And then what about all that small stuff you’re not supposed to sweat? Accounts up to date? Client notes completed and filed? Do you even know what being GDPR compliant would even look like?
If reading that made you feel slightly tense, it could be that you are incompetent and really need to ask yourself if private practice is for you, but more likely I tapped into your perfectionistic streak and your belief that if you’re not on top of everything, you’re a flop at everything.
When was the last time you saw a client whose presenting problem was perfectionism? Quite possibly never. People nearly always frame their problem as not being able to achieve perfection, rather than the feeling of being driven to achieve it. And so it is with those of us practitioners afflicted with the perfectionism bug.
Not being up to speed with life’s admin, and not always being in perfect psychological equilibrium are only problems if you think you should be. And if you think you should be, maybe you are a covert perfectionist.
Overt perfectionists are easy to spot. They are the super-tidy, super-organised people whose obsessive focus is an aspect of their functioning which, by its nature, is visible to all. But they are a minority in the vast tribe of perfectionists.
Covert perfectionists often go undiagnosed. An example of covert perfectionism in private practice would be falling behind with your admin because the standards you set for some aspects of your work are so high you are inordinately thorough and therefore slow. The term “clinical perfectionism” refers to perfectionism which is clinically significant but, when I first read it, I thought it referred to perfectionism in the clinic, by the clinician.
That thought doesn’t seem so stupid, when you think about how stressed many of us get when our clients’ symptoms don’t clear up quite as quickly as we think they should. This may be another sign of covert perfectionism. Many of us acknowledge our work is stressful, but how many of us recognise when our stress is due to our perfectionism?
Unfortunately, our working context seems almost designed to hook into our perfectionistic tendencies. When people are paying from their own pockets, the obligation to deliver really excellent treatment can feel greater than when delivering a similar service within the NHS.
There are so many pressures on us to do our best. Training and accreditation bodies stress high standards and competence. The companies which provide our indemnity insurance, and the referral agencies set out detailed and lengthy requirements, and have you seen the size of the fines if you’re not GDPR compliant?
Private practice often involves lone working, with little normative influence. On those rare occasions when you meet colleagues, perhaps at a conference, they just seem so contained and efficient you couldn’t possibly mention that you aren’t quite cutting the mustard. Much easier to cover up your embarrassment by buttoning up and appearing to be contained and efficient yourself…
…but maybe everyone else is doing the same thing. Maybe it’s time to talk more about perfectionism, to our clients, our colleagues, and ourselves. Maybe it’s time to push back against the culture of continuous improvement. Given the disproportionate cost and effort it generally takes to be better than necessary, maybe good enough is good enough.
Adam May will be hosting a webinar presented by Dr David Baker on Perfectionism at 9.30am on Wednesday, December 12th. Click here for further details: