Tales from the Therapist's Couch

Perfectionism means living in fear

Imagine this scenario. The woman across the room from me takes a seat in the consulting-room chair for the first time. Before either of us has spoken, she pulls a piece of paper from her pocket and tells me that she has drawn up a list of issues she wants to discuss. There is something painfully taut in her manner. I tell her I am happy to talk with her about whatever might be on the list, but that, as therapy is about making room for the unexplored rather than the prepared, it would be helpful to find time in the session to let go of lists and see where we get to.

Imagine this scenario. The woman across the room from me takes a seat in the consulting-room chair for the first time. Before either of us has spoken, she pulls a piece of paper from her pocket and tells me that she has drawn up a list of issues she wants to discuss. There is something painfully taut in her manner. I tell her I am happy to talk with her about whatever might be on the list, but that, as therapy is about making room for the unexplored rather than the prepared, it would be helpful to find time in the session to let go of lists and see where we get to.

My patient starts to read from her list: "Time management." This is a problem, she says, as she can never fit into the day what she needs to. She is the secretary to a successful businessman, and knows she is more efficient than most. But her boss keeps heaping more work on to her, so she has started working weekends to get the work done. Which leaves no room for anything else. Which gets to the next problem she has listed, which is "housework". She is worried because some obsessive part of her won't let her stop until the flat is spotless. She's concerned about what this is doing to her. Something happened, she tells me, that made her really worried, and which brought her here.

She tells me that she had invited some friends for Sunday lunch with their two children. She hadn't seen them for a while, and had spent a lot of time getting the place ready and thinking of foods that a two- and four-year-old might eat. She had been looking forward to the event, but what actually happened was simply and terribly chaos. The children ran riot around her home. The two-year-old peed on her rug. She had hated every minute, and wanted them to leave so that she could put everything back in order.

After they eventually left and she was clearing up, she had a flashback to her own childhood. Her mother, like her, used to clean the house obsessively, and she suddenly recalled coming back from school one day with a friend and wanting to play in her bedroom. Her mother had shouted at her that they had to play outside because the carpet had just been vacuumed. She remembered how embarrassed she had felt, and how her friend had turned away and said that she wanted to go to her own home.

And now, she says, I am like my mother. Unable to let life in because a clean house has become more important than human relationships.

All of us have ways of trying to impose some kind of order upon our inner and outer worlds. Many people use lists. Many work at weekends. But for some people, like the woman above, continually striving for impossible degrees of control and perfection has become something of an addiction: a pattern of behaviour that controls us, rather than one that is freely chosen by us. Such people have become the slaves of regimes and targets that drive them to exhaustion, but which they are terrified of loosening, or of letting go.

So why does someone continually push themselves to meet unrealistically high expectations? Why can't they take their foot off the pedal? Such patterns of obsessive inflexibility invariably develop in response to anxiety and fear. The father of the woman above was, for many years, an alcoholic. Her mother's obsession with cleanliness and order was probably a way of trying to ward off this terrible chaos in her life. And so she, her daughter, learnt to repeat this approach to life. Learnt, in other words, the saddest lesson of all: that the flow and flux of life cannot be trusted, and that the ego must do all it can to ward off fear by staying rigidly in control.

As the woman above so poignantly realised, her obsessive pursuit of perfection was cutting her off from life. Over the months that followed our initial meeting, she fought hard against the grip of her addiction to control. It takes tremendous courage to break the pattern of a lifetime, but gradually, very gradually, her prepared lists gave way to her recollection of unprepared dreams. Over and again she became amazed by the hidden life within her, and over and again she discovered, to her delight, that it was something that could, after all, be trusted.

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. No clinical material refers to specific cases

elizabeth.meakins@blueyonder.co.uk