Mükemmeliyetçiliği Şema Terapiyle Ele Almak: Bir Vaka Üzerinden Anlatım

Mükemmeliyetçilik, klinik anlamda kişinin işlevselliğinde önemli düzeyde sıkıntıya ve bozulmalara yol açan, aşırı yüksek standartlara sahip olma eğilimi olarak tanımlanmaktadır. Bu çalışmada şikâyetlerinin odağı mükemmeliyetçilik olan ve özellikle iş ve çalışma alanlarında buna dair sıkıntı yaşayan bir vaka ele alınmıştır. Çalışmanın amacı şema terapi formülasyonu ve teknikleriyle mükemmeliyetçiliğin nasıl çalışılabileceğini örneklemektir. İstanbul Arel Üniversitesi Klinik Psikoloji Doktora Programı şema terapi süpervizyon dersi kapsamında danışanla haftada bir, 50 dakika olmak üzere toplamda 11 seans yapılmıştır. Değerlendirme evresinde, danışana Young Mod Ölçeği, Young Şema Ölçeği, Young Ebeveynlik Ölçeği, YoungRygh Kaçınma Ölçeği ve Young Telafi Ölçeği uygulanmıştır. Kuramsal açıdan mükemmeliyetçiliğin mekanizmasında daha fazla rol aldığı belirtilen, başarısızlık, yetersiz özdenetim, yüksek standartlar, karamsarlık ve cezalandırıcılık şemaları, talepkâr ebeveyn, kopuk korungan ve kopuk kendini avutan şema modları ve uyumsuz başa çıkma biçimleri tespit edilmiştir. Bu şemalar, şema modları ve başa çıkma biçimlerinin zayıflatılması buna karşın sağlıklı yetişkin tarafın güçlendirilmesi, terapi hedefi olarak belirlenmiştir. Bu hedeflere ulaşabilmek için şema terapinin ilişkisel, yaşantısal ve bilişsel stratejileriyle müdahalelerde bulunulmuştur. Sonuç olarak, danışanın şikayetçi olduğu belirtilerdeki azalmalara ilişkin özbildirimleri değerlendirildiğinde mükemmeliyetçiliği köken odaklı şema terapiyle çalışmanın öngörülen değişim hedeflerine ulaşılmasını sağladığı tespit edilmiştir.

Approaching Perfectionism with Schema Therapy: A Case Study

Perfectionism is defined as the tendency to have extremely high standards, leading to significant distress and deterioration of functioning in the clinical sense. In this study, a case with perfectionism was the focus of the complaints especially in work and work related areas. The aim of the study was to illustrate how perfectionism could be studied with schema therapy formulation and techniques. Within the scope of schema therapy supervision course in Istanbul Arel University Clinical Psychology Doctorate Program, 11 sessions were conducted once a week for 50 minutes. During assessment stage, Young Mode Inventory, Young Schema Questionnaire, Young Parenting Inventory, Young-Rygh Avoidance Inventory and Young Compensation Inventory were applied to the patient. Accordingly, failure, insufficient self-control, unrelenting standards, pessimism and punitiveness schemas, demanding parent, punitive parent, detached protector, detached soother, vulnerable child schema modes, and maladaptive coping styles were identified. These schemas, schema modes and coping styles were aimed to be weakened, whereas the strengthening of the healthy adult mode was determined as the goal of the therapy. In order to achieve these goals, interventions were performed using relational, experiential and cognitive strategies of schema therapy. As a result, it was found that perfectionism-based schema therapy achieved the proposed goals which was also supported by the self-report of the patient.

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Antony, M. M., & Swinson, R. P. (2009). When perfect isn't good enough: Strategies for coping with perfectionism (2nd ed). Oakland, United States of America: Harbinger Publications.
Beck, J. S. (2011). Cognitive behavior therapy basics and beyond (2nd ed). New York, US: The Guilford Press.
Burns, D. D. (2000). Feeling Good: The new mood therapy the clinically proven drug-free treatment for depression. New York, US: HarperCollins Publishers.
Deas, S., Power, K., Collin, P., Yellowlees, A., & Grierson, D. (2011). The relationship between disordered eating, perceived parenting, and perfectionistic schemas. Cognitive Therapy and Research, 35(5), 414-424. doi: 10.1007/s10608-010-9319-x
Druss, B. G., Marcus, S. C., Rosenheck, R. A., Olfson, M., Tanielian, T., & Pincus, H. A. (2000). Understanding disability in mental and general medical conditions. American Journal of Psychiatry, 157(9), 1485-1491.
Earley, J. (2016). Self-therapy, a step-by step guide to using IFS for eating issues, procrastinaton, the inner critic, depression, perfectionism, anger, communication, an more (Vol 3). Larkspur: Pattern System Books.
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31(2), 203-212. doi: 10.1016/j.cpr.2010.04.009
Egan, S. J., Wade, T. D., & Shafran, R. (2012). The transdiagnostic process of perfectionism. Spanish Journal of Clinical Psychology, 17(3), 279-294.
Egan, S. J., Wade, T. D., Shafran, R., & Antony, M. M. (2014). Congnitive-behavioral treatment of perfectionism. New York / London: The Guilford Press.
Farrell, J. M., Reiss, N., & Shaw, I. A. (2014). The Schema Therapy Clinicians Guide: A Complete resource for building and delivering individual, group and integrated schema mode treatment programs. New York: Wiley Blackwell.
Flett, G. L., Hewitt, P. L., & Hallett, C. J. (1995). Perfectionism and job stress in teachers. Canadian Journal of School Psychology, 11(1), 32–42. doi: 10.1177/082957359501100105
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449-468.
Gnilka, P. B., McLaulin, S. E., Ashby, J. S., & Allen, M. C. (2017). Coping resources as mediators of multidimensional perfectionism and burnout. Consulting Psychology Journal: Practice and Research, 69(3), 209-222.
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social sontexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456-470. doi: b60. 456-70. 10.1037/0022-3514.60.3.456
Kırdök, O. (2004). Olumlu ve olumsuz mükemmeliyetçilik ölçeği geliştirme çalışması. Yayınlanmamış Yüksek Lisans Tezi. Adana: Çukurova Üniversitesi.
Klibert, J., Lamis, D. A., Naufel, K., Yancey, C. T., & Lohr, S. (2015). Associations between perfectionism and generalized anxiety: Examining cognitive schemas and gender. Journal of RationalEmotive and Cognitive-Behavior Therapy, 33(2), 160-178. doi: 10.1007/s10942-015-0208-9
Köse, B. (2009). Early maladaptive schemas and well- being with the moderator effect of balanced integration differentiation model. Unpublished Master’s Thesis. Middle East Technical University, Ankara, Turkey.
Köse Karaca, B. (2014). The effects of young schema domains, young maladaptive coping styles, and young parenting styles on working alliance among supervisors, therapists, and the clients. Unpublished Doctoral Dissertation. Middle East Technical University, Ankara, Turkey.
Köse Karaca, B. (2015). Therapeutic alliance among supervisor, therapist, and client trio and schema concept as the affecting factor: A Case analysis. Ayna Clinical Psychology Journal, 2(2), 13-39.
Köse Karaca, B., & Ateş, N. (2019). Yaygın Kaygı Bozukluğu ve Öfke Kontrol Probleminde Şema Terapiyi Kullanmak: Bir Vaka Üzerinden Anlatım. Ayna Klinik Psikoloji Dergisi, 6(2), 169-182.
Loose, C., Graaf, P. & Zarbock, G. (2018). Çocuk ve ergenler için şema terapi. İstanbul: Psikonet.
Luck, A., Waller, G., Meyer, C., Ussher, M., & Lacey, H. (2005). The role of schema processes in the eating disorders. Cognitive Therapy and Research, 29(6), 717-732. doi: 10.1007/s10608-005-9635-8
Maloney, G. K., Egan, S. J., Kane, R. T., & Rees, C. S. (2014). An etiological model of perfectionism. Plos One, 9(5), 1-9, doi: 10.1371/journal.pone.0094757
Pinto, A., Dargani, N., Wheaton, M. G., Cervoni, C., Rees, C. S., & Egan, S. J. (2017). Perfectionism in obsessive-compulsive disorder and related disorders: What should treating clinicians know? Journal of Obsessive–Compulsive and Related Disorders, 12, 102-108. doi: 10.1016/j.jocrd.2017.01.001
Powers, T. A., Koestner, R., Zuroff, D. C., Milyavskaya, M., & Gorin, A. A. (2011). The effects of selfcriticism and self-oriented perfectionism on goal pursuit. Personality and Social Psychology Bulletin, 37(7), 964–975. doi: 10.1177/0146167211410246
Rafaeli, E., Bernstein, D. P., & Young, J. (2011). Schema therapy distinctive features. London/ New York: Routledge.
Rice, K. G., & Preusser, K. J. (2002). The adaptive/maladaptive perfectionism scale. Measurement and Evaluation in Counseling and Development, 34(4), 210-222.
Sassaroli, S., Lauro, L. R., Ruggiero, G. M., Mauri, M. C., Vinai, P., & Frost, R. (2008). Perfectionism in depression, obsessive-compulsive disorder and eating disorders. Behaviour Research and Therapy, 46(6), 757-765. doi: 10.1016/j.brat.2008.02.007
Shafran, R., & Mansell, W. (2001). Perfectionism and psychopathology: A review of research and treatment. Clinical Psychology Review, 21(6), 879-906.
Simpson, S., Simionato, G., Smout, M., Vreeswijk, M. F., Hayes, C., Sougleris, C., & Reid, C. (2018). Burnout amongst clinical and counselling psychologist: The role of early maladaptive schemas and coping modes as vulnerability factors. Clinical Psychology and Psychotherapy, 26(1), 35- 46. doi: 10.1002/cpp.2328
Smith, M. M., Vidovic, V., Sherry, S. B., Stewart, S. H., & Saklofske, D. H. (2017). Are perfectionism dimensions risk factors for anxiety symptoms? A meta-analysis of 11 longitudinal studies. Anxiety, Stress and Coping An International Journal, 31(1), 4-20, doi: 10.1080/10615806.2017.1384466
Soygüt, G., Karaosmanoğlu, A., & Çakır, Z. (2009). Erken dönem uyumsuz şemaların değerlendirilmesi: Young şema ölçeği kısa form-3'ün psikometrik özelliklerine ilişkin bir inceleme. Türk Psikiyatri Dergisi, 20(1), 75-84.
Stoeber, J., & Otto, K. (2006). Positive Conceptions of perfectionism: approaches, evidence, challenges. Personality and Social Psychology Review, 10(4), 295–319. doi: 10.1207/s15327957pspr1004_2
Vreeswijk, M., Broersen, J, & Nadort, M. (2012). Handbook of schema therapy. UK: Wiley Blackwell.
Young, J. (1990). Cognitive therapy for personality disorders: A schema–focused approach. Sarasota, FL: Professional Resource Press.
Young, J. E., & Klosko, J. S. (1994). Reinventing your life: The breakthrough program to end negative behavior and feel great again. New York: Penguin Group.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy a practitioner's guide. New York/London: The Gulford Press.