
with Dr. Clarissa Ong
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Clarissa Ong
hi,
Dr. Celine Gelgich
I'm Dr. Celine Gelgich.
Dr. Tori Miller
And I'm Dr. Tori Miller. Welcome to Breaking the Rules. On Breaking the Rules talk about all things OCD.
Dr. Celine Gelgich
Obsessive compulsive disorder. OCD impacts up to 1 to 2% of the population. We are here to provide not just education, but to inspire clinicians, families and people who are impacted by OCD to be able to access the treatment they need in order to get better.
Dr. Tori Miller
Catch us every fortnight wherever you get your podcasts.
Dr. Celine Gelgich
Hello everybody. Welcome back to another episode of the Breaking the Rules podcast. We are joined today by the lovely Clarissa Ong, who is just so prolific in her research on ocd, anxiety and perfectionism. And she is going to chat to us about all those things as well as her wonderful book, the Anxious Perfectionist. Welcome to the show, Clarissa. Thank you for joining us.
Clarissa Ong
Yeah, thanks for inviting me.
Dr. Celine Gelgich
So tell us a little bit about yourself. What got you into researching anxiety and ocd and share a little bit with us about your wonderful research, if that's okay with you.
Clarissa Ong
Yeah, of course. I started doing research in college or in university when I was working with Randy Frost, who wrote the foreword for our book and he does research in hoarding disorder, which is One of the like OCD related presentations. And then I went to grad school and worked with Mike Tuek, who's a co author on the book the Anxious Perfectionist. And he does research on ACT acceptance and commitment therapy and ocd. And so I kind of got more into like ACT for hoarding, ACT for ocd. And then I think as I started thinking more about these presentations and thinking about what was maybe like similar or common among them, I got more interested in perfectionism as a sort of a more cross cutting pattern that's less diagnosis specific. And so then got more into perfectionism in. Now my research is sort of focused on more like non diagnosis specific like processes and ways to treat those more underlying patterns and more like process based work is what we would call it. But process means.
Dr. Tori Miller
What do you mean by that?
Clarissa Ong
Tell us more how process means and
Dr. Tori Miller
what it is that you're researching.
Clarissa Ong
Yeah, so I would say all of my research now is focused on like process based therapy and process based principles. And so by that I mean focused on processes of change or processes of stuckness, I guess, either way. So like kind of broader patterns that are more defined by their effect on the person's life rather than what they look like. So for example, imperfectionism. We think a lot about rigidity with respect to rule following, right. If I have a rule, like I should be nice, right? Like I should always be nice even if someone is mean to me or even if I need to stand up for myself. There's this rule of like I need to be the nice person, I need to be agreeable. And so that might look like saying yes all the time or that might look like, you know, not being assertive. So it might look like different things. But the underlying process of I'm following the rule that I need to be nice all the time is constant. So kind of focusing more on those underlying patterns, more so and also focusing on helpful processes of change. So in act, we think a lot about psychological flexibility, which is a little broad, but I would say that's a general process of change. So the ability to, when I have this rule or urge popping up that I want to be nice or I should be nice, I'm able to say, hmm, does this situation call for being nice or not? And then be flexible and choose accordingly, right? And so that might mean sometimes saying yes, but that might also mean saying no. And so it looks different, but the pattern is for being more flexible. So kind of focus on that. Focusing on individual level functioning. So rather than on a group level, how are people doing, but how is each person doing? Because when we think about the group, we kind of wash away all those very, you know, meaningful individual differences. Right. We know everyone's different, but when we flatten everyone to an average, then we just lose some of that, I don't know, complexity. So, so mostly do treatment research and it's thinking about these sort of levels of analysis, I guess.
Dr. Tori Miller
Oh, sorry, you go explain. I was, I could see us both kind of going.
Dr. Celine Gelgich
And I had myself on mute. So that sounds really, really amazing because a lot of the things that we talk about to our supervisees and people that we work with is what, you know, this concept of what's driving OCD behavior or anxiety or perfectionistic behavior. And we kind of formulate it in terms of form and function. So form being, you know, what do you see, what are the symptoms and then functions sitting underneath that in terms of what's the purpose of this. So it's really lovely that you're gathering research and you're, you know, the data around that because it gives us language to what's going on and helps us understand some of those processes. And it's very. Well, I think, correct me if I'm wrong, like, you know, I think it's rare to see that in the OCD literature as well. Like a lot of it's ERP based and outcome driven and a huge focus on reduction of symptoms. And I think now that we're looking at it and understanding it as, understanding it as such a complex layer of, well, layer of complexity. Really complex layer of complexity. Then. Yeah, like it's, it's really great to be able to, to get gain insight into that. Yeah, I think that's really helpful.
Dr. Tori Miller
What are some of the, I mean you've, you've spent a long time now looking into ocd. I mean, are there particular things that you found really interesting about OCD and anxiety? I mean, what of all the things you've researched, what's really stood out to you?
Clarissa Ong
Oh, that's a really good question. I would say in terms of research, probably the perfectionism, like pattern really stands out to me. So I'm doing more research on that and I think it kind of feeds itself in the sense that the more research I do on it, the more I learn about it and the more I learn about what I don't know. Like I think about someone who knows a topic really well, knows what they don't know. Right. Like, that's certainly how I think about someone who's familiar with a topic. So the more I learn about what I don't know, the more interested I am in it. So it's. I'm sort of like in that cycle. I find perfectionism interesting because it can show up in so many different ways because it can be associated with so many different symptoms or problems. Right. It could look like someone who would meet diagnostic criteria for depression or someone who would meet diagnostic criteria for OCD or for generalized anxiety disorder or an eating disorder. But it's interesting to me that if we look like beneath the surface of symptoms, you might see really familiar patterns. And so when I work with clients with perfectionism, at some point we kind of like, oh, right, this is that all or nothingness. Or like, oh, this is the rule following. Even though their presentations look really different. But on like a just non research level, what if I re. I really like working with clients with OCD because I find the sort of like mental, like the mental barriers or mental cage of OCD really fascinating. That like, I think that feeling of like, I can't do it is so strong. Right? Like I can't, like, I can't not wash my hands or, you know, I can't not arrange this, even though physically is like totally possible. But I think like, the strength of that, like I have to is so strong. I just find that like, really fascinating for some reason. And for whatever reason, it just stands out to me more in the context of ocd, even though I'm sure that's true for many different presentations.
Dr. Tori Miller
Tell us more about perfectionism. Let's go. Celine and I love talking about perfectionism. If we're inspired quite a lot by your work actually. But
Dr. Celine Gelgich
yeah, both painful perfectionists.
Dr. Tori Miller
And we've really started thinking about it and working with our team and our supervisees and talking about, on the podcast about, about the importance of keeping an eye out for perfectionism. Perfectionism and weaving it into the formulation because it is so influential on a person's presentation and their functioning and as a predictor of outcome. We would love you to just maybe the starting place is for you to just define perfectionism as you conceptualize it in your work.
Clarissa Ong
Yeah. And I also would be very interested to hear about what, how you are like, conceptualizing it, because I think you can think about from so many different angles. So. Well, I answer first, so it's not like I'm cheating. So I think of perfectionism really like as, at its core as rigidity with respect to rules. And I think that can manifest in lots of different ways. But primarily when we're so Rigid with respect to rules, then all the other kind of pieces of perfectionism show up as well. So then I get very distressed when rules cannot be followed, or I get very angry when other people can't follow my rules. Or if I really follow my rules, then I don't really know what I want in life because all I'm doing is following rules. So I never had a chance to think about what do I want in life. Same thing with identity. Like, if I'm just like, this is who I should be, then I've also never had a chance to explore different identities, try on different things that might fit, and then choose which one actually kind of makes me feel most fulfilled. So I think. I think of it really at its core about that and everything else around it kind of emanates from that. And I think that's probably an oversimplification, but at least for me, it really helps to keep a more kind of focused conceptualization. But then I think you can kind of fit people's specific presentations onto that framework.
Dr. Tori Miller
Where do you think the perfection. I mean, where do these rules come from? So why is it, do you think that some people end up with such rigidity around rules?
Clarissa Ong
Yeah, that's a good question. I think there are lots of possible determinants. So I think commonly there's a lot of parental expectations, right? So from the time you're really young, this has been sort of, like, ingrained in you. And I think it's not always conscious. I don't always think it's a parent or parent saying, you need to be perfect, or if you're not good, I'm not going to love you. But I think sort of through implicit messages, right? So, for example, if I get a B on a test and my parents are like, oh, that's great. And then whenever I get an A, they're like, oh, like, you're so amazing. Like, we're so proud of you. Like, it sends an implicit message, like, we like you more when you do better at school. School. Or we like you more when you and your races. So I think there's that. I think there's societal pressure. I think we, like, on average, as a society, we really. What's the term looking for? Is it like, valorize? Or, like, we really, like. Like. I think of Steve Jobs as such a. Like a quintessential perfectionist, right? Like, he's super. I mean, my understanding is he's very mean to everyone. Like, he couldn't buy furniture because there's no perfect furniture. Like, you know, but we think. I think on average, society thinks, like, wow, he's such a genius. Like, I want to be like Steve Jobs, right? And then there are people who, like, want to dress like him. But, you know, I don't know him, obviously, but I don't know, like, how his quality of life was. But imagine if you can't buy furniture for your home. Like, that's pretty stressful. If your employees, you know, feel like you're pretty mean, that's probably, you know, not, you know, pretty stressful. But then because he's so successful, it's like, well, yeah, he's just a, you know, a genius. And I think we have a lot of those stories. So I think there's societal pressure. I think usually in our field, there's also a lot of that. I know, like, therapist perfectionism is. Is the thing. And I think of that too, even when I'm working with my clients, like, oh, I didn't say that right? Or, oh, I should have done that metaphor. That would have been so much better. I. I always think of good metaphors after session, but not in session. So I think there's that. I think another thing I've been thinking more about, too, is almost like perf as a form of compensation. So sometimes for people, let's say, like, I'm thinking, like, neurodivergent presentations, like, let's say adhd, where perfectionism can feel like a way of, like, okay, fine, if I can't, you know, totally pay attention in class, I'm gonna record everything, and then I'm gonna, like, take my notes really well so that I can make sure I'm, like, catching up. I think it also provides a sense of control sometimes for people. So I'm thinking people have had a trauma history. That perfectionism, that sense of, like, you know, if I just do everything exactly this way, then I'll have control over what happens. Can feel comforting in a sense. So I think there are lots of different reasons, and I think that's also part of what makes the presentation, like, interesting. Because it's not always like, you know, my parents. I think parents are really common, to be honest. But it's not always that. Yeah, I'm. I'm curious what how you talk about in your practice with your supervisees.
Dr. Celine Gelgich
I often talk about it as being multifaceted because especially with clients. Clients have sometimes more of a black and white understanding of perfectionism. Like, they think of it as. As it being an aesthetic thing or just order and symmetry, you know, that kind of stuff. Supervisees Depending on level of experience and background. You know, it's similar, but we, yeah, absolutely, talk about it as a multifaceted beast really and touch on a lot of the topics that you'd covered as well. Especially the one where there's, you know, you, you talked about trauma. We cover relational trauma more. Where there's, you know, family dynamic, issues with family dynamics and, and the subtle messages that you talked about. I think that can be reinforcing and really shed a light onto what drives a lot of the. The perfectionistic behavior and helps with the formulation and gives some aha moments because there are so many layers to perfectionism and it can show up in so many different ways. And one thing that stood out for me recently, which I've been really interested in learning a little bit more about and reading a bit more on, is perfectionism that comes out of neglect in early childhood experiences where the person then overcompensates and kind of goes too far in the other direction. Not only for control but also for a sense of, you know, not wanting to be like their caregiver that was neglectful and build a sense of self. But almost it, it's this overshooting the mark, so to speak, and providing inflexibility and rigidity where it just, you know, takes away from that as well. For in terms of being able to. I'm kind of now thinking about OCPD type presentations where it creates,
Clarissa Ong
I guess,
Dr. Celine Gelgich
discord in interpersonal relationships and. Is that the, is that the word? Am I looking for discord Discourse? Yes, discord. Yeah. It's 10:30 at night. Yeah. Discord in interpersonal relationships. And they end up losing out in a sense anyway. So it's kind of like if I engage in this behavior, you know, I won't be anything like my parent who was neglectful or who was. Yeah. But then. Yeah, the overcompensation, I think really it's like a double edged sword. It kind of. Yeah. Ends up being unhelpful anyway, I guess is what I'm trying to say.
Clarissa Ong
Yeah.
Dr. Tori Miller
And I'm. And I'm quite like you like.
Clarissa Ong
Yeah.
Dr. Tori Miller
Do you know, Clarice, it was really surprising to me when you talked about perfectionism. I mean, it surprising me that, I mean, when you talked about perfectionism manifesting in things like depression, I get it and I'm sure that I've kind of thought about it before. But when I define perfectionism, my mind almost immediately goes to the sort of the anxious presentations. And of course that's not true and I know that, but it's interesting that, you know, to say that out loud, I had to. If I was to define perfectionism, I probably wouldn't have stretched the thread so far. And I, I probably the place that I start is thinking about those, you know, those unrelenting standards and the fear of what will happen if you don't stick to the rules. And,
Dr. Celine Gelgich
and
Dr. Tori Miller
that's, yeah, that sense of, of just being really uncomfortable and afraid of not measuring up in whatever, whatever those standards are and whatever the situation is. And. But one of the things that I find really interesting that I've now started to, you know, talk about and think about more, which I actually was really, I learned from your book actually was thinking about perfectionism as being both helpful and unhelpful. Like not thinking about it. I'd always defined it as a really unhelpful beast, like you said before, Celine. And I've, you know, got a long history of perfectionism which has been incredibly unhelpful. And, and so for me, you know, it's caused me a huge amount of anxiety in my life and you know, in areas where like I, I didn't take risks and I, you know, have spent ages ruminating on things that are just so meaningless. I think the point at which I realized my perfectionism was quite unhelpful was when I was perseverating on the color of my lipstick that I'd worn to an event and whether it was or wasn't the right shade to have worn. And I think that was the moment where I kind of went, this is like just reaching the ridiculous. What is this? What is this? But, but when, But I also really respect the value of perfectionism and the drive that it can give. And I really like the way that in your book you make that distinction about the difference. And I wonder if you could talk to us a little bit about that because I think that that is so important. Well, it has been for me at least and really influential in my work.
Dr. Celine Gelgich
Yeah, it is extremely important.
Clarissa Ong
Yeah, yeah. So I think about.
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Clarissa Ong
Trying to think like a girl. I guess one piece is thinking about context, right? Like a new behavior is helpful and helpful and it depends on context. Even a behavior that we might think, oh, this will never be helpful. In theory, there will be some context where it is a lipstick thing. Like, so, for example, is there some context where.
Dr. Tori Miller
Yeah, like it was really important to choose the right.
Clarissa Ong
Yeah, so, so let's say like, and I mean this like in theory, right? Like if, if, if someone was like, you know, I'm gonna kidnap you unless you write the you wear the right lipstick shade. It's like, yeah, you wanna ruminate on that. In theory, yeah. But I think it's that a lot of times these behaviors are removed from a context where they would be helpful. So for example, I ruminate a lot on conversations that I have with people. I probably ruminate about this after. And there's probably some situation where, oh, you know what, I'm doing a podcast in two days, so I probably do want to think about what I said now and then think about how, you know, do I want to say things differently. But I don't have a podcast recording in two days, so it's probably not going to be very helpful. Maybe it'd be helpful for me, you know, in months if this is relevant again, but not, certainly not tonight when I'm trying to fall asleep.
Dr. Tori Miller
So
Clarissa Ong
I think it's like sort of context dependent. I think also like the, I think sometimes like, Like there's parts of perfectionism that can feel more ego syntonic. Like this is sort of like important to me even without fear. There are some elements of perfectionism I still care about. So for example, like, you know, I have to be the best, might be more anxiety driven, but I care about my work ethic or, you know, I care about being able to support other people. Like that side of it is, I think more values based, maybe more values consistent. So I think it's, it's almost like if you can find like the elements of the perfectionism that are much more like, this is important to me. And even without fear, this is who I would want to be. And I think those pieces can be helpful to sort of leverage. But I think the anxiety can get in the way or sometimes I think of it like the rules can sometimes look like a, like a perversion of values where it's like you care about other people so you should always say yes whenever people ask you for help. Right. Because you care about people and you know, our all or nothing thinking goes like if you don't say yes, it means you're a bad friend or it means you're a bad daughter or a bad parent. Right. Or like you care about good work ethics so you should work till 2am every day. Right. If not, it means like you obviously don't care about your work. But then the underlying value of like work ethic or kindness or you know, being present for my family, I think all that can still be really meaningful for people.
Dr. Celine Gelgich
I think it's a really important distinction to always think, like to think about the context as you described because we can get stuck in those. And you make such a great point in terms of the, that fusion with our values sometimes can kind of. We like, you know, weigh in really heavy and then we forget about ourselves, don't we? We're you know, other focused and we forget that self care in those moments is equally important. And that can lead to things like burnout. And it's this never ending marathon of chasing perfection which I think kind of for me makes sense, can lead to things like depression and that sort of stuff as well. But coming back to what we were talking about earlier, it kind of brought up a thought for me. And I'm just to hear your thoughts on this as well because as Tori said, we see perfectionism as like this doing thing right, where it as an active kind of motivating set of behaviors. But I'm wondering like if, if the standard is set so high and the I can't be bothered achieving that, like I'm not even gonna achieve it. So why even bother? Is that what that depression, what that form of depression looks like is, is what are your thoughts about that?
Clarissa Ong
Yeah, I'm glad you brought that up because I realized I didn't talk about the sort of other side, which is I think. And I did the same thing. Like I was thinking of that sort of high achieving, like relentless striving form of perfectionism, but I think the other form, because we have this all or nothing pattern, it's whatever, I'm not gonna do anything. So I also sometimes have clients where it's like in a certain domain of Their life. It's like very striving in another domain. It's. I can't be bothered. So for example, a client who, you know, like it's at the library till closing, like a, let's say a college student, a university student, the library till closing. But then their apartment or dorm room is a total mess. It's like, you know, like leftover food left everywhere. So it seems like, oh, it seems like someone who works so hard would also have a very. But it's sort of, well, I can't maintain it the way that I would like. So I'm going to give that up. I'm going to focus on work. So I think how like depression might show up. I think one way is that way it's that it looks like lack of motivation. But I think what's interesting, it's almost like it's like internally my impression is like people are just spinning their wheels. They're like, should I, should I not? Like when should I start? And there's actually a lot of stress around it. But from the outside it looks like, oh, this is such a bad student or this is such a bad employee. They're procrastinating all the time, they can't meet any deadlines. Like, you know, I don't like working with them. But internally it's, they might have written like 20 drafts or they might have been sitting for five hours not being able to put out any words because no word is good enough or correct.
Dr. Celine Gelgich
So I think that sounds painful.
Clarissa Ong
Yeah. So I think that lack of motivation. I think another aspect is that self worth piece. Right. In depression, we think a lot about guilt and worthlessness and I think there's a lot of self criticism in perfectionism. So I think that sense, it could be, you know, have these standards, I know I'm not meeting them and therefore I'm worthless. Like, what's the point of life if I can't even do something so basic? So I think it can also show up in that way in terms of depression. And then the ruminations also I think usually associated with depression. And I think it could also show up as the sort of lack of interest in things because if everything needs to be done to a certain standard, I don't think anything will be very fun. I've definitely had clients where they can't even enjoy movies because it's like if I can't hear every single word, you know, every time I watch a movie, I need to know exactly what's happening.
Dr. Celine Gelgich
And that is, that's my husband, he Gets subtitles on every Friday freaking time.
Clarissa Ong
Yes.
Dr. Celine Gelgich
And then we have to press pause and go back.
Clarissa Ong
And then we have to press rewind.
Dr. Celine Gelgich
Yes. The last few minutes or whatever. And I'm like, sorry, Clarissa, I cut you off this beautiful train of thought. I was like, oh, my God, it's him. So he. He'll hate me for saying this cuz he gets embarrassed. Sorry. I still love you. Please don't divorce me. So, like, if I'm like, our house isn't massive. It's tiny. Our kitchen's like two steps from where the TV is. And I'll quickly go and grab something. And he'll press pause, bless him, because he's thinking of me because he doesn't want me to miss it. I'm like, I can still hear it. Like, it's cool. I'm okay. And he's like, but. But what if you can't. I'm like, it's not. It's all right. Like, context, like, it's good. I appreciate you thinking of me. And. But now I'm just used to him pressing pause. And now I just was like, now I'm the one saying, let's press pause, pause. I don't want to miss. Anyway, so.
Clarissa Ong
Well, he's not alone, so that helps.
Dr. Celine Gelgich
No, that's good to know. Yeah, yeah, yeah. It's pain. It's like, I think, like it feel. It must be. I don't know if it's painful or not, but it's just. It's a thing. Yeah, absolutely.
Dr. Tori Miller
Yeah. Like it. It sounds like. Like it's paralyzing. Like it makes people get really stuck, unable to move on. It would be. Yeah, yeah. It would be really. It would be really difficult. Incredibly difficult. Clarissa, I'm. I'm curious because your. Your book, the Anxious Perfectionism, very much is about acceptance and commitment therapy for sort of anxiety perfectionism, which certainly very much aligns with the kind of work that Celine and I do. But I'm very curious about your thoughts on ACT versus CBT here because, I mean, traditionally, CBT would have been how we would have, as therapists, would have navigated this, I think, and I suspect is probably still for a lot of students who are coming out of university, is still what students are being taught. You know, that sort of rudimentary, you know, Socratic questioning, which is a technique that I love, but also a lot of thought challenging. Why did you and Michael lean more towards exploring it at the sort of the intervention for perfectionism from the ACT perspective rather than CBT or even other Methods like schema therapy and things like. Can you tell us a bit about that?
Clarissa Ong
Yeah, yeah. So besides that, we're an ACT lab, so we just have to do ACT all the time. It was because. So if I think of perfectionism as sort of as characterized by rigidity, the point of ACT is to kind of cultivate psychological flexibility. So in our mind, it's like, oh, like, if ACT is about flexibility and the problem of perfectionism is about inflexibility, that seems like a really good fit. So that's kind of why we were thinking, oh, act. Like, let's see what happens if we apply ACT to perfectionism. And in our research context, as I'm sure clinicians have been doing that way before us. So I think that was part of the motivation and learning more about it. I think it just made more and more sense. So I was, you know, mostly trained in act, and so I think my knowledge of CBT is probably lagging behind my knowledge of act, but. And I think you can do CBT very experientially. But I think ACT is sort of almost. I feel like being experiential is so, like, inherent to act or it's sort of like, really important in act. And I think that piece I found to be really helpful when working with folks who struggle with perfectionism.
Dr. Tori Miller
For those who.
Clarissa Ong
Because it's.
Dr. Tori Miller
Sorry, no, I was just gonna say for those who maybe don't know what you mean by that experiential component. Can you define that for us and give us some examples?
Clarissa Ong
Yeah, So I think it's. I think there's a couple ways I think about it. So one way I think of is, like, working with whatever's showing up in session. So rather than like, you saying, okay, so when you feel anxiety, like, let's talk about how you're going to practice some acceptance work or some willingness we might catch when a client is. When we notice a client's feeling anxiety in session, and it's like, okay, like, tell me what's showing up for you. Okay? And then we might even say, like, I just, like, let's, like, see if we can notice that without trying to control it. Like, you know, notice it like a sunset or like waves crashing on a shore. You know, whatever your chosen kind of metaphor is. So I think that's one aspect. I think another aspect is going for function rather than form. So a really common thing I think of with perfectionism is they'll do their homework really well. And for most clients, you'd be like, oh, yes, this is Great. But with perfectionism, I might go for the function of that. So the form is great. People are doing therapy, homework. The form is, oh, I need to please my therapist, or everything I do, I have to do it to the 110%. So I might go after that instead. So maybe that's less experiential, but it's more like, you know, we're. We're thinking about, like, what is driving the behavior, like you were saying. So I think those are a couple ways or even when. I mean, you can do it with most things, like. So if clients, like, like, can you explain to me how to do the exercise again? Like, you know, for between session practice, you know, rather than. Okay, so when we talk about acceptance, this is what we mean. Sometimes I'll say, yeah, I don't know, like, why don't you try it and then tell me, tell me what you find out kind of thing. So whereas I wouldn't do that for any, you know, all my clients. So I think that serves that experiential thing rather than engaging on that content level. There's a bit of, like, we're just gonna work with whatever's coming up using
Dr. Tori Miller
the back and forth, using relationship. Yeah, really dialoguing about things rather than that sort of psycho education model where you sort of. You teach, you give behavioral instruction, you send them away to do.
Clarissa Ong
Yeah, yeah, yeah, exactly. That's. Yeah, like teaching by having them do it rather than by telling them how to do it. Yeah, that's a good way of. Yeah, yeah, thanks for that.
Dr. Tori Miller
What does intervention for perfectionism look like?
Clarissa Ong
So I think in act, I feel like there are these pretty basic components or building blocks of act, like, in terms of the skills that we teach. So in act, we teach acceptance willingness skills, which is. Or being open to whatever thoughts and feelings show up. There's a diffusion skill which is like, can I sort of treat thoughts and feelings for what they are, not what they say they are? Right. So instead of fear being like, this is scary and you know, I need to get rid of it, it's, oh, wow, my heart's beating really fast. So sort of being able to see them for what they literally are, you know, there's like, values work, which is what's important to you, and so on and so forth. So intervention with act, I think, is about thinking about how do I teach these skills in a way that is accessible to the client with perfectionism. And usually experiential work is one way to do it. I've definitely had clients where cognitive restructuring From CBT works really well. So it's, you know, it's not like one way is better than the other. I think it's just, you know, depends on your client. And I think sometimes that experiential style can undercut a lot of the intellectualizing, which is really common. Just like sort of they get in their heads. It's like, okay, I need to figure it out. And it's the same thing with values. I think I find that aspect really interesting, which is when values sort of get subsumed into perfectionism rather than sort of become an alternative to rules. So it's like, well, I need to know what my correct value is and then I can start doing valued action, right? Or I need to be like totally ready to engage in my valued action. Then I can do valued action. Or like, oh no, I didn't live according to my values. Like, oh like I'm such a bad person. Because since I know my values I should be able to follow them, right? So it can sort of just become part of that pattern even more.
Dr. Tori Miller
So yeah, that's very interesting, that idea of the value sort of being integrated into the perfectionism as opposed to being seen as a way to navigate perfectionism. Yeah, that's very interesting. Do you know what's the, what's the relationship, do you think, between OCD and perfectionism? How do these two. Are they just. Is it just. Is it quite. Would you say it's quite common? What has your research told you?
Clarissa Ong
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Don't sound like everyone else With Grammarly you never will. Download Grammarly for free@Grammarly.com. I would. I. I'm trying to think if we have specific research on that. But I. I think clinically, my impression is it is. There's a lot of overlap because almost by definition, like OCD is, I have these thoughts that I have to get rid of or neutralize or manage in some way, and I engage in compulsions or rituals to get rid of those thoughts. And I think there's some. I'm not sure if it's specifically in the diagnostic criteria, but there's some implication of rigidity. Right. Like, I have the thought, I have to do the compulsion. I guess you can have a thought without. Anyway, that's a separate conversation because I don't really think that that's possible, but. Or, you know, our mental compulsion. So I think in the sense of that rigidity, I do think that really looks like perfectionism. But I think, like, you're saying perfectionism is really multifaceted, like, to the extent that it affects how we view others, how we view ourselves, how we view the quality of our life or the, you know, the behaviors that we've done. So I almost feel like perfectionism is a broader construct. So, for example, when we were recruiting people for our clinical study on ACT for perfectionism, we thought, oh, we're gonna get a bunch of people, and then we, you know, do a diagnostic interview for research reasons, and we're like, oh, we're gonna get a bunch of people who meet criteria for ocd. But the majority of people were people who met criteria for generalized Anxiety disorder, or gad, which is really characterized by worry about lots of different things. And so. And I think that was not expected to me are. You know, at the time, because I was, oh, I thought for sure this is like an OCD thing, like, or ocpd. And so I think that's what made me think more about how it shows up in general. Anxiety and depression. And it's like, oh, yeah, yeah, I see how it's. It. It fits there, but because I could
Dr. Tori Miller
really see how the perfectionism sits underneath generalized anxiety disorder. And that would have. Would. Would really drive that rumination.
Clarissa Ong
Yeah, yeah, yeah.
Dr. Tori Miller
What does your. What's your research said about the efficacy of. And the effectiveness of ACT for perfectionism?
Clarissa Ong
So we've done, I think, one randomized clinical trial so far, and the. The results. I'll be very nuanced about it. We compared our treatment group to a weightless control group. We didn't have a very strong control group, as opposed to ACT versus cbt, we found that, on average, people did better in the treatment group relative to the weightless control group, but that's a minimum bar. It's like people who did nothing and then people who did something. So I think more like rigorous testing is probably needed. And I think that's only if we want to see is this better than cbt. But yeah. And then we also, I think another finding that was important as we noticed like again just in our trial, a rebound effect in value action. But I don't think as much for the other variables like self compassion or symptom distress. So it seems like there's something about sort of keeping up that momentum of engaging in values based action that might have been difficult for some people, even though like more stable traits like self compassion sort of still in that sort of post treatment range. So I think that was another thing that's like helpful to think about clinically. And I, and I can see that just as from a therapist perspective, I feel like it's always harder for people. Like they might have, you know, the more like how I see myself might be like once that's shifted, might be harder to shift back, but the like keeping up with like daily value behavior might be harder to do. So I could see that happening.
Dr. Tori Miller
Why do you think that as well? Why is that?
Clarissa Ong
Oh, like specifically why is valued action like
Dr. Tori Miller
that makes me curious because when I think about the implications of that for our intervention, this is something that we are sort of a philosophy that we're trying to teach that I would hope our clients would, would be internalizing and then able to take forward outside of just the intervention for their, you know, for their mental health difficulties, but into all aspects of life. But it sounds a little bit like that's actually hard to sustain. And that makes me curious because that is something for us to watch for or to assist with. Yeah. What do you, do you have any ideas about that?
Clarissa Ong
Yeah, I wonder if there's a bit of, I wonder if there's some of the all or nothing pattern that kind of shows up a bit. So even if it's not as extreme as at the start of treatment, let's say there could be some like, oh, I didn't do it this week, so like. Or I didn't do it today. Okay, I'll start again next week or something like that. I also think of it for myself like when I, you know, make new behavioral commitments or we think about New Year's resolutions, right. It's like, okay, like yeah, I'm motivated, I'm gonna do it. And then it just like kind of tapers off over time. So there's something about, there's Something about. I don't know. I mean, it's a really good question. I feel like if I knew the answer to help myself sustain call to action better. But there's something about, like. There's like the. Oh, yes, I'm very motivated at the start, and. And then life happens, stress happens, and then you kind of, you know. And I think that scale of, okay, like, I went off track. How do I get back on track? Probably. I think now that I think about is probably that that's the skill that might be missing because it's almost like, oh, sorry.
Dr. Celine Gelgich
No, go on, go on.
Clarissa Ong
Oh, I'll just quickly say, I think it's. In therapy. I almost think of it like, we're keeping people on track less so, like, let them get off track and then teach them how to get back on track. So I wonder if it's that. But, yes, I mean. Sorry, go ahead.
Dr. Celine Gelgich
No, no, no, no, no, no. Yeah, I can really relate to that with my clients. Like, a lot of them have that very pattern of, you know, have the session happens, they're motivated for a few. Few days, maybe a week, and then, exactly like you said, life happens. And then they fall off the wagon a little bit, and then they, you know, come back in, they get the little boost, and off they go. And I. I wonder if. I've often wondered if some of that is. Sorry, I'm distracted by my. I'll cut that while. Tell the editor to get rid of that. So I wonder if some of that is the elements of perfectionism coming in, as you mentioned before, and setting these standards of treatment needing to look a particular way or clients needing to do things a certain way. And if I don't do it that way or, you know, Clarissa explained it to me this way, and I'm not quite sure if I understood her properly. So I'm gonna wait till I go back and see her before I do anything. And so the perfectionism turns treat. Turns treatment into a thing, and very much so starts to hamstring treatment, and that's when it can get in the way. And I often say to my clients, I'm like, really? This too? It's gonna take this away from you as well. And so we joke about it a little bit, but then also call it out and talk about how much it impacts and how now treatment is becoming a thing as well. And so. Or principles of treatment. And it can be a really challenging aspect of treatment to overcome. And I almost think there's a really strong fusion with values at that point, too. And I wonder, you may have mentioned this, but I wonder if talking about flexibility with values as also being something that we need to talk about with our clients. As much as I love values guided action and live by it, I think we need flexibility there as well. What are your thoughts?
Clarissa Ong
Yeah, I totally agree. I think another pattern with values is, oh, I like what I. And this is, I think, a common question among therapists as well, which is, oh, but what if, you know, my client has a family value and a friend value and they conflict or something like that. This idea of, like, values, value clash, values clashing or conflicting. And I remember we talked about this in supervision, and I think I'm pretty sure it was Mike. And he sort of talked about, well, like, it seems like a values problem, but this might actually really be more like an acceptance diffusion problem, where it's more about like, like allowing ourselves that we are not going to meet our values 100% of the time, and that's going to feel uncomfortable and can we make room for that? And I really kind of liked that conceptualization that this is actually not a values problem as much. So I think it is. It's the letting go of the rule of I have to, you know, meet my values 100%. And I think part of, you know, human pain and complexity is we will never be able to do all the things we want to do, and we will never be able to be exactly like that person that we want to be. And like. And that's sort of like the paradoxical nature of values. And we still, like, work towards the. Even if we'll never meet them. And I think that's really hard for someone who's very outcomes oriented to.
Dr. Tori Miller
And, you know, listening to you, both that kind of. And thinking about the clinical perspective and, you know, the kind of the toing and froing and the coming and going,
Clarissa Ong
I guess,
Dr. Tori Miller
that our clients do. It made me also think about, you know, what. What are our expectations for our clients? I mean, we're talking about perfectionism and their expectations for themselves that they're bringing to us. But I think it's very easy for us to get caught up in our own expectations for ourselves as therapists and the expectations we then project onto our clients in terms of their progress. And you're so right, Clarissa. In terms of, like, what does real life look like and what does values led, you know, living a life driven by your values look like? And it's not going to look like you're meeting, you know, making perfect choices every time and. And so to a degree, that kind of ebbing and flowing is almost to be expected. You know, how could we do it all the time? And isn't that just part of life? That. This is partly why I like act based work, because I love the dilemmas that arise for us as human beings that offer us an opportunity to just think about ourselves and who we are and what we want to do about it. That it is not about not having the dilemmas, it's about giving us a way to navigate the dilemmas. And. Yeah, and. And so I suppose as therapists, we have to be aware that, you know, we are not setting our clients up to be pursuing perfection as, as clients in their treatment, because, you know, that doesn't exist.
Clarissa Ong
Yeah. And I think, Sorry, Hannah, alarm's going off out there. I got distracted. Oh, my gosh. I forgot what I was gonna say. Oh. I think another, like, sort of slightly tangential, I think about with clients with perfectionism is a lot of times, because we have been so focused on the rules, and I say rules, but it could be standards or expectations or, you know, sort of any like, sort of thought that is followed rigidly. That when we say, like, okay, like, what if we let go of the rules? Like, very often I get a response of, but I don't know what else to do. So then there's this like, vacuum where it's like, well, tell me what to do and I'll do it. And then it's sort of like, give me another. Give me the better rule, and then I'll follow that one. And so I think a lot of times there's so much trial and error in, I think, treatment where it's like, you know, I don't know what that looks like. You don't know. But like, can we be willing to try out different stuff even if we don't know that that is exactly it. And like, sort of be sensitive to the feedback that you get when you do try different stuff. But I think that willingness to do something, even if you don't know if it's the right thing, I think is a really big part of treatment for perfectionism. And I think that can be really, really tough for people because it's like, you. You should know the answer. Just. Just tell me and I'll do it. Like, you know, don't try any, like, Jedi tricks on me or anything. I can definitely relate to that.
Dr. Celine Gelgich
Yeah. Is that particularly the case for people, like, for neurodivergence, like, where they rely on certain rules and expectations and to get them Through.
Clarissa Ong
Oh, I don't. I don't have a lot of experience working with Neuro. Well, at least not explicitly that I would know of. But I think having. But like kind of just thinking broadly, I feel like having the rules is okay. I think it's the being flexible around the rules that we want to encourage. So it's okay to have the rule of I need even something like I need to be successful, but as long as we can treat that rule flexibly and hold it lightly. Because it's not the rule itself that's the problem. It's that rigidity around the rule.
Dr. Celine Gelgich
Yeah.
Clarissa Ong
So I think we don't want to say, like, kind of earlier Tori was talking about like recognizing their helpful pieces and unhelpful pieces, like the rules themselves. They're sort of rules. It's how we interact with them that can create problems. Like. Yeah, so like the thought, you know, I am worthless is not unhelpful unless we believe it kind of thing.
Dr. Celine Gelgich
Yeah. Yeah.
Dr. Tori Miller
I'm gonna pause there for a second. Yeah, I reckon this is really great. I reckon that's a good place for us to start our wrap up. What do you reckon? Yeah, yeah, yeah, yeah, yeah.
Dr. Celine Gelgich
Sounds good. This has been so enlightening, as always. And we just, you know, there's. We could talk about this for days and days and days and days because there's just so much of it that I can relate to that I see patterns in my clients that you've talked about and I'm sure Tori has too, you know, as our listener, as our listeners would as well. So thank you so much for shedding so much more light on this. There's. There's a lot that we can learn. And for anyone who wants to read more, please follow Clarissa and the amazing work that she does as well as her colleagues. Before we wrap up, we. We usually finish up with a couple of questions for our guests, one of which is, would you be willing to share a couple of intrusive thoughts that come up for you so we can normalize that process in terms of everybody experiences intrusive thoughts.
Clarissa Ong
Yeah, I think for me it's more about like, how do I pick which
Dr. Tori Miller
ones
Clarissa Ong
I need people to like? Me is a really big one. So people pleasing is something I really struggle with. Another one is it's sort of this, like, I need to get this done. So a bad habit, an unhelpful habit I have is, you know, it's the end of my work day, but I'm like, oh, I'm so close to Getting it done. So I have this like, you need to finish it. Just get it done. And then I end up, you know. Yeah.
Dr. Celine Gelgich
Half an hour later.
Clarissa Ong
Yeah. Or like two hours later. Yeah. Yeah. So those are probably two. I, I, I, Yeah, so I think those are two.
Dr. Tori Miller
The other question that we ask all of our guests is whether there's something that they know now that they wish they knew earlier in their life or in their career.
Clarissa Ong
I probably related to my intrusive thought. And it, I think it's not everyone will like you. And that's just how it is. I think, I think that especially I think like doing like, so when I do workshops and stuff, like you get feedback and, and I think I always like, want it to go, you know, quote perfectly. And it's like, oh, everyone should find this helpful, but no one will. And I think I tend to take it very personally. And I think, and so that's something I'm working on. But I think that like, just like, not everyone will like all the things that you do and like accepting that is kind of part of the journey. And I think that probably I wish I had known that sooner. It's something that a lot of my mentors like, tell me and it's, it makes a lot of sense now.
Dr. Tori Miller
Well, thank you so much, Clarissa, for joining us. It has been really, you've been on our wish list for a while to talk to and certainly your research and your book has been invaluable to us as clinicians, but also to our colleagues and, and to the clients that we work with. We're often recommending it. Thank you so much for all the work you do. It makes the work that we do possible.
Dr. Celine Gelgich
Yeah.
Dr. Tori Miller
So thank you.
Clarissa Ong
Oh, thank you so much.
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Hey guys. Welcome to Giggly Squad, a place where
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Welcome to the squad.
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Episode: Perfectionism, Process-Based Therapy & The Anxious Perfectionist
Hosts: Dr. Celine Gelgec & Dr. Victoria (Tori) Miller
Guest: Dr. Clarissa Ong
Date: March 23, 2026
In this rich and insightful episode, Drs. Celine Gelgec and Tori Miller are joined by esteemed researcher and clinical psychologist Dr. Clarissa Ong, author of The Anxious Perfectionist. Together, they delve into the nuances of perfectionism, its relationship to OCD and anxiety, and the evolving use of process-based therapies—especially Acceptance and Commitment Therapy (ACT). With personal anecdotes and deep clinical wisdom, the discussion provides practical takeaways for clinicians and those affected by perfectionistic traits.
[02:22–06:32]
“I got more interested in perfectionism as a more cross-cutting pattern that’s less diagnosis specific…”
—Dr. Clarissa Ong [03:14]
[08:13–19:48]
“When we’re so rigid with respect to rules, then all the other pieces of perfectionism show up as well.”
—Dr. Clarissa Ong [11:54]
[19:48–23:32]
[23:32–26:22]
“If you can find the elements of perfectionism that are much more like, this is important to me... and even without fear, this is who I would want to be. …the anxiety can get in the way.”
—Dr. Clarissa Ong [26:22]
[29:33–32:22]
[32:22–33:43]
[33:43–39:15]
“If ACT is about flexibility and the problem of perfectionism is about inflexibility, that seems like a really good fit.”
—Dr. Clarissa Ong [35:18]
[39:45–45:45]
“It’s almost like, the rules can sometimes look like a perversion of values… you care about good work ethic so you should work till 2am every day. Right. If not, it means you obviously don’t care about your work.”
—Dr. Clarissa Ong [27:20]
[45:45–47:09]
[46:07–54:31]
“There’s something about... I went off track. How do I get back on track? Probably that’s the skill that might be missing, because it’s almost like... in therapy we’re keeping people on track, less so letting them get off track and then teaching them how to get back on track.”
—Dr. Clarissa Ong [49:01]
[56:18–59:14]
The all-or-nothing cycle of perfectionism:
“I’ve definitely had clients where they can’t even enjoy movies because it’s like, if I can’t hear every single word...”
—Dr. Clarissa Ong [32:07]
On society’s valorization of perfectionism:
“My understanding is [Steve Jobs] is very mean to everyone. Like, he couldn’t buy furniture because there’s no perfect furniture. But we think, on average, society thinks, ‘Wow, he’s such a genius.’”
—Dr. Clarissa Ong [13:55]
Personal anecdote highlighting perfectionism’s reach:
“The point at which I realized my perfectionism was quite unhelpful was when I was perseverating on the color of my lipstick that I’d worn to an event and whether it was or wasn’t the right shade.”
—Dr. Tori Miller [23:06]
Values and flexibility:
“Part of human pain and complexity is we will never be able to do all the things we want to do... And that’s sort of the paradoxical nature of values... And I think that’s really hard for someone who’s very outcomes-oriented.”
—Dr. Clarissa Ong [54:12]
[60:29–62:32]
For more from Dr. Ong, consult her book The Anxious Perfectionist and her published research. The conversation continues with more resources at Melbourne Wellbeing Group and in future episodes of Breaking the Rules.