What to Do When Perfectionism Shows up in Treatment

Exposure and Response Prevention (ERP) is the gold standard care for obsessive-compulsive disorder (OCD). For more information on ERP, you can read our blog on An Overview of ERP. Perfectionism and “just right” are common subtypes in OCD and with these subtypes, therapists may notice difficulties with individuals wanting to do ERP perfectly. Before tackling addressing perfectionism in treatment, let’s clarify that perfectionism in OCD is driven by an intense fear of making mistakes, failing, or not meeting rigid and self-imposed standards, which leads to compulsive behaviors. Back to it.

When perfectionism shows up in ERP, clients may struggle with wanting to complete exposures in the right way, ensuring that they feel sufficiently anxious, or eliminating all compulsions immediately. Clients may also seek reassurance that they are doing the ERP exercise correctly, make efforts to redo an ERP if it didn’t feel perfect or right, and attempt to compare their progress to other clients.

As therapists, it’s important to recognize and address perfectionism in treatment early. Otherwise, clients may become stuck, avoid exposures altogether, or feel discouraged when ERP doesn’t go exactly as they imagined. Here are some tips to help clients move past the trap of “perfect” ERP and embrace a more flexible, values-driven approach.

1. Normalize the Discomfort of Imperfect ERP

Clients who struggle with perfectionism may believe they need to execute ERP flawlessly for it to work. They might say:

“I don’t think I did that exposure right.”
“I wasn’t anxious enough, did I do it wrong?”
“I think I accidentally neutralized my exposure.”

When this happens, validate their concerns while gently challenging their need for perfection. You might say:

“It makes sense that you want to do ERP ‘right’. OCD often pushes for certainty and perfection. But recovery isn’t about getting it perfect; it’s about showing up and tolerating uncertainty.”
“Feeling unsure about whether the exposure was effective is actually part of the work. The goal is to practice flexibility, not certainty.”

Helping clients accept the messiness of ERP can be a valuable exposure in itself.

2. Shift the Focus from Performance to Process

Clients with perfectionism often focus on ERP as a task they must complete correctly rather than a process of learning and growth. They may view exposures as tests they can pass or fail, rather than opportunities to develop tolerance for discomfort.

To counter this, emphasize the process over the outcome:

Instead of: “Did I do that exposure correctly?”
- Encourage: “What did I learn from this exposure?”
Instead of: “Was that exposure hard enough?”
- Encourage: “Did I allow uncertainty rather than seeking reassurance?”

Reframing ERP as a flexible process, rather than a rigid set of rules, helps clients engage more effectively without the pressure of perfection.

3. Use Values-Based ERP to Challenge Perfectionism

Perfectionism often stems from rigid rules and fear of failure. Incorporating values-based exposures from Acceptance and Commitment Therapy (ACT) can help clients shift their focus from doing ERP “right” to doing it in a way that aligns with what matters to them.

For example, if a client struggles with completing an exposure perfectly, ask:

“Why are you doing ERP in the first place?”
“What does recovery mean to you?”
“How does tolerating imperfection help you live a fuller life?”

Encouraging clients to align their ERP work with their values, whether that’s being more present for their family, pursuing their passions, or simply reclaiming their time from OCD, can make it easier to accept the discomfort of imperfection.

4. Introduce Exposure to Imperfect ERP

If perfectionism is a major roadblock, choosing exposures that target sitting with imperfection can be helpful. Consider the following interventions:

Purposely “imperfect” exposures: Encourage clients to do an exposure in an imperfect way, maybe skipping a step, doing it out of order, or not fully completing it, to help them tolerate the anxiety of imperfection. Other routines or tasks can be utilized for this exposure as well. For example, writing a poem that has mistakes and leaving them, painting a picture and not redoing parts that don’t look perfect.
Uncertainty tolerance exercises: Have clients practice saying, “Maybe I did that exposure wrong, maybe I didn’t,” without trying to resolve it.
Exposure to failed ERP: Clients may fear “not doing enough” ERP. Try an exposure where they intentionally “don’t do enough” and sit with the uncertainty of whether they did ERP correctly.

By directly exposing clients to the discomfort of imperfect ERP, they can learn to accept that recovery doesn’t require perfection.

5. Model Imperfection as a Therapist

Clients often look to their therapist for cues on how to approach treatment. If we model flexibility and imperfection, it can help them do the same. Try:

Admitting when you make small mistakes (ex: “Oops, I said the wrong thing, good thing we don’t have to be perfect in here!”).
Reframing perceived “mistakes” in therapy as learning experiences.
Gently redirecting perfectionistic tendencies with humor and self-compassion.

By creating a space where imperfection is not only tolerated but embraced, clients may feel safer letting go of rigid expectations in their own ERP work.

Conclusion

Perfectionism in ERP can be a sneaky barrier to progress, but it’s also a great opportunity for therapeutic work. Helping clients reframe their expectations, embrace uncertainty, and engage with ERP flexibly can lead to more sustainable recovery.

The goal isn’t perfect ERP, it’s imperfect, consistent practice in the face of discomfort. Practice makes progress, not perfect.