by 
I was a baby when I stepped out into the world of physiotherapy in 2007. I was young, excited, with a spring in my step and an unshakeable confidence; determined to get that first job as a physiotherapist and succeed.
I didn’t realise it at the time, but I was a perfectionist.Committed to doing things the ‘best’, and often quite competitive with myself and others.
In 2012 I started writing a book for physiotherapists. Along the way among the extensive research and reading I did, I learned a lot about my own perfectionism and the role it had played in my career (and episodes of burnout) up until that point. It was humbling and eye opening to say the least.
These days I am much less about achieving perfection in anything (whether personal or professional), and instead much more about having a go, about honesty, and being willing to make mistakes (and owning up to them.)
Below is an excerpt from my new book coming out this September. It’s an academic style of writing, designed to be a secondary text for final year physiotherapy students, and new graduates. It’s called:
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Perfectionism, Over-commitment and the High Achiever
“You are imperfect, you are wired for struggle, but you are worthy of love and belonging.” – Brené Brown
Perfectionism
Perfectionism is a trait commonly found in health professionals. A relationship has been established between perfectionism, stress and burnout among psychologists and doctors, although this same link has not yet been made for physiotherapists.[i] [ii]
A review article explored perfectionism among the gifted (Silverman 2007) and defined it in two lights; one positive and one negative.[iii] The negative light depicts perfectionism as psychologically unhealthy, which may be counterproductive to the development of people who possess this trait but does account for some people with perfectionist tendencies. Silverman claims that perfectionists may have underlying issues of low self-esteem, low confidence, procrastination and a propensity to set high standards for themselves, with subsequent experiences of guilt and shame when they don’t meet these standards. Silverman goes on to describe the positive traits that allow people who identify as perfectionists to work hard, be willing to try new things (without fear of failure), and learn from their experiences as well as their mistakes. Striving for perfection is essential in the case of elite athletes, scientific breakthroughs and extraordinary works of art, which are all achieved through the perfectionistic personality. These traits have also been linked with reaching higher levels of consciousness, the realisation and fulfilment of one’s potentialities (self-actualisation), and a drive to perform great humanitarian deeds.
Silverman reflects on the research of Hendlin (1992)[iv] and Greenspon (1999)[v] to provide an alternative viewpoint, which is to consider excellence versus perfection. Excellence is defined as the ability to strive for excellence and derive personal satisfaction from performance. Striving for excellence (rather than perfection) can indeed reflect healthy self-esteem and involves a strong desire to do well, master a task, challenge oneself and be the best one can be. In contrast, perfectionists are seen as needing to excel purely to bolster self-esteem, which is not considered to be healthy.
It is worthwhile noting that while striving to be better can have positive effects on one’s life and the lives of those around them, constantly focusing on being ‘better’ in the future can cause people to lose sight of the positives in the present! Mindfulness (something we’ll explore in another blog post) can help anyone to stop and appreciate the here and now.[vi]
Whether one is striving for perfection or not, it is important to realise that there will be many things on a daily basis that are out of control, and it is beneficial to pause, take a deep breath and surrender. These things include clients who cancel, or don’t get better even when it was hoped they would; and personal and professional plans that do not turn out as expected.
Perfectionism doesn’t just relate to drive – it may be wanting to ‘appear’ perfect in front of clients, such as by demonstrating an ability to follow protocols in health such as eating a balanced diet, following exercise guidelines and keeping fit. While there is little research in this area, it can be hypothesised that the physiotherapist who feels constantly ‘on display’ may feel a burden to maintain a healthy regime. The practitioner may at times feel scrutinised by peers, family or the community, either for being ‘too healthy’ or for being seen to be ‘unhealthy’, such as when ordering takeaway after a busy week, or failing to keep up with a regular exercise regime due to illness, or surrendering to the general demands of work and life. The practitioner may feel internal conflict when giving advice to clients when they themselves are not feeling very healthy. This raises the issue of authenticity and ‘practising what you preach’. Clients can see through a well-rehearsed speech about diet and exercise, and they may only take advice seriously if their clinician appears to be healthy, relaxed, and functioning at their best. It’s wise to remember that we are all only human after all, and to allow ourselves grace periods when we aren’t feeling our usual sense of wellbeing.
It can be daunting for new graduates to work with experienced practitioners and see their expertise and finely tuned skills. For the new physiotherapist with perfectionist tendencies, it can be frustrating to be a novice. One must remember that experience develops over many years and cannot be rushed. Even the experienced physiotherapist who has been practising and mastering their skills for decades has more to learn – the commitment to lifelong learning is something all health professionals must embrace.
Over-commitment
The close cousin to perfectionism is over-commitment. This is defined as ‘to commit excessively and therefore obligate oneself beyond the ability of fulfilment’.[vii] There are times when the requests of employers and family need to be met, and saying yes to certain demands may be required. At other times it is important to re-evaluate which commitments are taken on and work out what is essential and what is negotiable. Volunteering, committee work, or professional development activities all need to be monitored throughout the year for appropriateness.
One of the best ways to avoid over-committing is to use the twenty-four-hour strategy. When faced with a new request that has no clear answer, taking twenty-four hours to make the decision can be a useful strategy to help reduce over-commitment. This allows time to decide whether the request aligns with one’s values and personal agenda. Saying yes when it is not convenient will ultimately lead to resentment and a potentially negative outcome. Learning how to say yes with enthusiasm when you’ve established that it aligns with your goals and you have time to take it on, and politely and diplomatically declining when it doesn’t, is an essential life skill.
The High Achiever
The pathway into physiotherapy may be directly from school or it may be via transfer from another health degree, depending on the educational institution. For the student wanting a career in physiotherapy, human movement, nursing or other health degree (and hoping for a transfer), the stakes are high. Physiotherapy is a competitive field, and it’s not an easy course to get into as it typically attracts high achievers with high scores from their schooling. High achieving (also termed a ‘proactive personality’ in the literature) has been correlated with taking initiative, displaying take-charge behaviour, speaking up and seeking opportunities. [viii]
It can be hypothesised that many physiotherapists will be high achievers, so it helps to develop a deeper understanding of how to manage high-achieving tendencies. The notion of the ‘good-enough practitioner’ was explored by Skovholt and Trotter-Mathison in their book The Resilient Practitioner. This theory reassures helpers across many fields that they are indeed adequate, and can and will get by with the knowledge and skills they possess right now.[ix]
Being ‘good enough’ means that no matter where the physiotherapist is on their career journey, they can trust themselves, feel confident in being ‘good enough’ for clinical practice and commit to mastery at some point in the future.[x]
This ‘good-enough practitioner’ theory is useful for the novice, as they are particularly susceptible to negative self-talk, which threatens to uncover the novice as a fraud. This concept of feeling like a fraud was termed ‘imposter syndrome’ by American researchers Pauline Clance and Suzanne Imes in 1978.[xi] Imposter syndrome entails holding a secret belief that one is not deserving of success and recognition. This commonly held fear of being ‘found out’ can be distressing for a new graduate, and even for an experienced practitioner who feels they are not adequate for their role. The good-enough practitioner theory can help the novice to develop sufficient awareness and healthy self-reflection practices to acknowledge their own growth (without expecting to know everything at once).
Also associated with high achieving is the ‘Type A’ personality. The Type A personality, originally described by Friedman and Rosenman (both cardiologists) to assess the behaviour of cardiac patients, has now been renamed as the Type A behaviour pattern.[xii] This behaviour pattern is characterised by competitiveness and striving. It is broken down into two separate components: (1) Achievement Striving, which is characterised by hard-driving task orientation, taking one’s work seriously and expending effort to achieve; and (2) Impatience/Irritability, which reflects time urgency, anger, hostility, and aggressiveness (this may be overtly expressed or internalised). Research shows that Achievement Striving is positively correlated with academic and occupational success, whereas Impatience/Irritability is correlated with poorer health outcomes including increased risk of coronary artery disease.
Other literature on this subject from Ryckman et al. (1990) proposes the notions of personal development competitiveness versus hyper competitiveness.[xiii] People displaying traits of personal development competitiveness have learned to compete with rather than against others to achieve their personal goals. They may focus less on the task outcome and more on the enjoyment inherent in the task itself, which leads to task mastery, self-discovery and self-improvement. In comparison, hyper competitiveness is similar to the Impatience/Irritability subtype, with traits of hostile aggressiveness and the need to win at all costs. Low self-esteem, reduced interpersonal trust, dogmatism and the need to control others may also be elements of this personality trait. Understanding these subtypes among employers and colleagues may help to reduce conflict in the workplace and enable practitioners to work to their strengths.[xiv]
Setting exceptionally high standards, pushing too hard to achieve and failing to schedule breaks for relaxation can be troublesome attributes of the high achiever. But on the positive side, these attributes (when kept in check) can help a novice to better meet the needs of their clients and ultimately fulfill their own potential.
References
[i] D’Souza, F, Egan, SJ & Rees, CS 2011, ‘The relationship between perfectionism, stress and burnout in clinical psychologists’, Behaviour Change, vol. 28, no. 1, pp. 17-28.
[ii] Craiovan, PM 2014, ‘Correlations between perfectionism, stress, psychopathological symptoms and burnout in the medical field’, Procedia-Social and Behavioral Sciences, vol. 127, pp. 529-533.
[iii] Silverman, LK 2007, ‘Perfectionism: The crucible of giftedness’, Gifted Education International, vol. 23, no. 3, pp. 233-245.
[iv] Hendlin, SJ 1992, When Good Enough is Never Enough: Escaping the Perfection Trap, JP Tarcher
[v] Greenspon, TS 1999, ‘Perfectionism is not healthy’, Annual Meeting of the National Association for Gifted Children, Albuquerque, NM.
[vi] Irving, JA, Dobkin, PL & Park, J 2009, ‘Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR)’, Complementary Therapies in Clinical Practice, vol. 15, no. 2, pp. 61-66.
[vii] Definition of overcommitment, n.d, Merriam-Webster Dictionary, viewed 1 July 2019, https://www.merriam-webster.com/dictionary/overcommit.
[viii] Lang, J, Kern, M & Zapf, D 2016, ‘Retaining high achievers in times of demographic change: The effects of proactivity, career satisfaction and job embeddedness on voluntary turnover’, Psychology, vol. 7, no. 13, pp. 1545.
[ix] Skovholt, TM & Trotter-Mathison, M 2014, The Resilient Practitioner: Burnout Prevention and Self-care Strategies for Counselors, Therapists, Teachers, and Health Professionals, Routledge.
[x] Russell, R 2017, ‘On overcoming imposter syndrome’, Academic Medicine, vol. 92, no. 8, pp. 1070.
[xi] Clance, PR, Dingman, D, Reviere, SL & Stober, DR 1995, ‘Impostor phenomenon in an interpersonal/social context: Origins and treatment’, Women & Therapy, vol. 16, no. 4, pp. 79-96.
[xii] Friedman, M 1974, Treating Type A Behavior and Your Heart, Fawceff Crest.
[xiii] Ryckman, RM, Hammer, M, Kaczor, LM & Gold, JA 1990, ‘Construction of a hypercompetitive attitude scale’, Journal of Personality Assessment, vol. 55, no. 3-4, pp. 630-639.
[xiv] Okoro, CM, Okonkwo, EA, Eze, AC, Chigbo, CM & Nwandu, IB 2018, ‘Competitiveness among employees in the workplace: The influence of conflict handling styles and organisational types’, IOSR Journal of Humanities and Social Science, vol. 23, no. 6, pp. 82-89.
Elizabeth is a Physiotherapist, Naturopath and Author who lives in the Adelaide Hills with her husband and little boy. When she is not working and writing you will find her adventuring in the hills with family and friends.
This blog post contains excerpts from Elizabeth’s first book ‘The New Graduates Guide to Physiotherapy’– Available in September!
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