How Perfectionism Shows Up in Therapists

Perfectionism in therapists doesn’t usually look like obvious perfectionism. The therapist who spends three hours preparing for a 50-minute session, then writes an hour-long progress note, then carries the case home in their head for the rest of the evening, is running a perfectionist pattern even when the surface looks like dedication.

Three places it shows up most reliably.

Over-preparation. The standard preparation for a typical CBT session is 10 to 15 minutes: read last week’s note, check the homework submissions, review the formulation. The perfectionist version runs 45 to 90 minutes. Re-reading the case file. Researching adjacent literature. Drafting possible session structures. The over-preparation produces marginal clinical improvements at best. It costs hours of your week.

Note-writing that runs long. A clean session note is five sentences and takes two minutes when the data is on screen. The perfectionist version runs to half a page or longer. Comprehensive narratives. Multiple alternative interpretations. The notes aren’t more clinically useful at length. They’re harder to read later, and they took thirty minutes per session you don’t have.

Carrying cases home. You leave the office and the case stays running in your head all evening. You’re rehearsing what you should have said, drafting next session’s plan, weighing whether the formulation needs revision. The mental rehearsal is sometimes useful. Mostly it’s the perfectionist pattern dressed up as conscientiousness, and it’s exhausting.

Each of these has a structural cap.

Cap session preparation at 15 minutes. Set a timer if needed. Read last week’s note, check the submissions, review the formulation, write down one sentence on what you’ll open the session with. Stop.

Cap note-writing at five minutes. Use a brief structured format: one quote from the client, one sentence on the focus of the session, reference the homework, name the next-week assignment. The structured note is more useful than the long narrative anyway because it’s scannable next session.

Cap evening case-thinking at zero. The cases live in the file. The file is on screen tomorrow morning when you prep. You don’t need to carry the case in your head all evening. The structure holds it for you.

In my-cbt, the case file holds everything you’d otherwise carry. Notes attach to sessions. Submissions sit alongside. The formulation is in the Information tab with version history. You can offload the cases at the end of the day knowing the structure will hold them until tomorrow’s prep.

The perfectionist pattern doesn’t fully go away. It does loosen when the structural caps are in place and the case file is doing the work of remembering. You walk out of the office with less in your head, and the rest of life has more space.