PORCELAIN DOLLS
A Cognitive-Behavioral Approach to Breaking
Through Perfectionism and People-Pleasing
In Women
Dr. Carly LeBaron, LMFT

PRESENTATION OUTLINE
 What is a Porcelain Doll?
 Perfectionism
 Definition
 How it presents
 People-Pleasing
 Definition
 How it presents
 Contributing Gender Issues
 Socialization
 Cultural roles, rules, & expectations
 Compassionate CBT Treatment Approach

PORCELAIN DOLLS
 What do they look like?
 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?

PERFECTIONISM
 Definition
 Setting excessively, sometimes impossibly, high performance standards accompanied by overly critical selfevaluations 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.

PERFECTIONISM
 The Benefits 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

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?

PEOPLE-PLEASING
 Definition
 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

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

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

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?

GENDER ISSUES
 GIRL RULES:
 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

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

TREATMENT APPROACH
EVENT EVENT EVENT EVENT EVENT
 Cognitive process MENTAL ILLNESS FILTER (DEPRESSION, ANXIETY, OCD, EATING DISORDER, etc.)
POSITIVE
CORE
BELIEFS
NEGATIVE
CORE
BELIEFS
FEELINGS

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

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)

TREATMENT APPROACH
 STOP, It’s Narrative Time!
 The importance of EXTERNALIZING
 The Mask Activity
 What Perfect Looks Like/Feels Like,
 What Real Looks Like/Feels Like

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.

TREATMENT APPROACH
 Assertiveness Training
 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

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

TREATMENT APPROACH
 Homework
 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

QUESTIONS OR COMMENTS
Contact Information:
Dr. Carly LeBaron, LMFT
Utah Valley Counseling
2230 N. University Parkway,
Suite 11D, Provo, UT
(801) 407-4134 carlylebaron@utahvalleycounseling.com
(Feel free to grab one of my cards with my contact info!)