I’m Dr. Morgan Levy, a psychologist specializing in therapy related to anxiety and perfectionism. Ask me anything!

What advice would you give to students who are avoiding school due to anxiety? Or, what advice would you give to teachers of high school students who are avoiding school due to anxiety?

School avoidance is so common and it so often gets misjudged as a child being defiant and just being a “difficult kid.” I would encourage students to tell someone how you are feeling. It’s so difficult open up, so I would suggest trying to find one adult that you can trust and feel safe with.

My number one piece of advice for teachers is to be open to the signs and listen when a student is struggling. Don’t immediately assume that they are just being defiant for the sake of being defiant. It’s also SO important for teachers and educators to talk about mental health and therapy so that it has less of a stigma in schools. Teachers should reach out to resources on campus (hopefully there are resources – I know many schools are short-staffed with mental health professionals).

To relate this to perfectionism, a lot of high school students are facing an increased amount of pressure to perform well and get straight A’s. I think teachers who encourage a well-rounded approach to life can make a huge impact. I notice a trend on focusing on performance rather than well-being and it’s unfortunate.

Here is a resource list for educators: https://apps.nasponline.org/search-results.aspx?q=school+refusal

Also, to all teachers, I seriously applaud you for all that you are doing – especially during this pandemic.

Thanks for the response! Unfortunately, for many of us (teachers), we ARE the support resource on campus. And we are woefully undertrained in how to respond to a child with anxiety.

Yes, that's so unfortunate. You all have to do so much. It may be helpful to see if there are community mental health care centers or other low cost clinics in your community. If you have a list then it might be possible to provide that to parents of students that you are concerned about. I recognize it may be difficult if the parents aren't receptive though. I would also suggest reaching out to the school psychologist (I believe every school should at least have access to one in their district? I may be wrong though.)

If you could sum up the underlying thought or belief that a perfectionist needs to embrace, to go from desperately needing to be perfect... to embracing the imperfect reality of life for a happier existence.. what would it be?

If you could sum up the underlying thought or belief that a perfectionist needs to embrace, to go from desperately needing to be perfect... to embracing the imperfect reality of life for a happier existence.. what would it be?

That all we need is to be good enough, not perfect. :) It can feel very freeing to realize that you don't need to be perfect.

But doesn't this provoke the reply of what constitutes 'good enough'? And provide the self-fufilling loophole that promotes the perfectionists problem by allowing them to define 'good enough' as perfection?

Absolutely! Great point. Usually in therapy that is one of the factors we work on. We work to delineate what is good enough versus what is just another rule/standard. It's also important to explore what exactly is preventing someone from feeling like they are enough and how realistic their expectations are. Please let me know if you have further thoughts! I appreciate the discussion!

Thank you I appreciate your time!

What comes to my mind is this Bruce Lee quote:

"A goal is not always meant to be reached, it often serves as something to aim at."

In this sense couldn't it be argued that aiming high, even impossibly so and in a perfectionistic way, doesn't have to be considered an unhealthy thing?

And in that vein I would be curious to know in your experience how many perfectionists that you've dealt with are actual real-world achievers that are not afraid to take-risks to try to achieve those extreme standards for themselves.. versus those who are perfectionists that have extreme standards but in their life suffer paralysis by analysis and dont have the courage to really even attempt to take any steps to live up to the standards that they themselves have adopted?

I love that quote. It also reminds me of practicing mindfulness and being in the moment rather than striving to reach a goal. So many perfectionists are actually super successful. It's usually their perfectionism that has led them there. Perfectionism is not always a bad thing. Like everything else, there is a balance. I would say the difficulty comes when this perfectionism is pervasive and is impacting all areas of their life (e.g., relationships, family, hobbies). Also, usually people who experience difficulty getting started and taking steps to meet standards are experiencing that stuckness due to the fear of failure. They might fear that if they get started they will fail and their inadequacies will be exposed. It's easier to procrastinate and avoid than to potentially experience those feelings.

Okay so.... where do I go from here? Haha I apologize for hijacking this thread but this has been seemingly speaking to me personally and my experience. I've been stuck somewhere between the procrastination element and being paralyzed in the ideas stage (needing the perfect direction before actually starting).

I know this is probably something that can't be detailed over a reddit conversation, but I really do appreciate your effort to help bring this insight to light. Are you accepting digital clients😀?

I appreciate you sharing all of this! I'm glad that this thread is speaking to you. If you are looking for a therapist I recommend checking out https://www.psychologytoday.com/us or https://internationaltherapistdirectory.com.

I do provide online video therapy to individuals living in the state of Florida.

How do you deal with patients that undergo imposter syndrome?

How do you deal with patients that undergo imposter syndrome?

Imposter syndrome is super common. I see imposter syndrome soooo much. It’s interesting because in my experience usually people who are considered conventionally successful experience it the most. Perfectionists might often view their accomplishments as just sheer luck and that they just happened to get to where they are and didn’t really earn it/deserve it based off their own merit. When I work with those individuals, I try to work with them on addressing the underlying low self-esteem and self-worth. We also work on self-confidence. Sometimes these feelings come from childhood and the belief that in order to be loved and accepted by others that they need to succeed and be perfect.

Do you know if there's been any work done to investigate a possible link between a decrease in training and employee development across multiple industries, and the increase of imposter syndrome?

Ooh...good thoughts. I am not aware of any research on this, but I would love to learn more!

How do you help a perfectionist gain perspective?

Usually perfectionists have extremely high standards for themselves that are almost impossible to meet. This creates an endless cycle of feeling not good enough and consistent self-criticism which can then lead to feelings of anxiety and depression. It’s also likely that because of these high standards – a perfectionist may feel a really strong need to control and they might be overconscientious. It’s also likely a perfectionist has certain “rules” and “shoulds” that they apply to their life, but they may not really know where these rules come from (in my approach to therapy we typically explore how these beliefs originated in childhood).

Not one perfectionist is the same or has the same life story – so therapy is likely to look slightly different for everyone. I’ll talk about the approach that I generally take (please keep in mind that this is just one approach – there are experts in other styles of therapy and I don’t want to pretend like I know them all! )

Usually, I will work with a client to understand how the perfectionism is impacting their life and to understand what they would like to change. We then dive deep to understand where the perfectionism comes from and what purpose it served for them when they first noticed it. Usually, this self-exploration and understanding helps create a perspective shift. We typically work to examine other possible explanations and perspectives that could be possible. One of my favorite mantras is that the goal is to be “good enough.” Perfection is unattainable (and in my opinion, doesn’t exist). I hope this answers your question!

It’s good enough! 😉 Thanks!

Haha :)

I tend to suffer from "analysis paralysis" in a few areas of my life. Diet and schoolwork have been the main obstacles. What are some small steps I could take to make progress when I am in this rut?

In general, when we set large goals for ourselves we can become overwhelmed and just give up because of how overwhelmed we feel. It can be easier to make progress if we break down one large goal into a bunch of little goals. Also, sometimes this avoidance is due to the fear of making mistakes. If this is the case, it may be helpful to do the task and accept that there will be mistakes and that you can always go back and fix/adjust them later. Something that helps me get things done is to tell myself “progress, not perfection.”

What impact does a perfectionist have on their family / what are the general consequences of perfectionism on one's family life, that you've diagnosed/treated/counseled?

It can create some real difficulties when a perfectionist starts applying the standards that they hold for themselves to the people in their life. They might start acting irritable, critical, and maybe even lash out. It’s also likely that they resent the people in their lives who seem to not care about being perfect and are able to live a more carefree life.

Sometimes the perfectionism is a result of childhood trauma or childhood pressure which leads to feeling unsafe in relationships. This could lead to someone not feeling truly safe expressing their feelings to others and holding in/bottling up their feelings because some negative emotions may be considered “less than perfect.” This could create a barrier in communication and may prevent intimate and honest relationships. I've worked with a lot of individuals who crave realness in their relationships and they find that the pressure to always be "perfect" and to never look bad/fail really prevents that from happening.

As a parent, sadly, this hits home for me. It gets confusing for me sometimes though. Like, where does tough love become too overbearing or not sensitive enough? I often get upset because I truly care for my children and want the best for them but I know it may also have to do with my own feelings of inadequacy and how I was treated as a child. Self awareness in these situations goes out the door and reaction(like what happened to me as a child) just happens in these moments. Because of this my children are sometimes afraid to just talk to me openly and makes me sad. Does that make sense? Do you have any suggestions for self help?

In general, when parents are reacting impulsively, it may be helpful to see if there are parent training sessions offered by mental health clinics in the community. Some parents also use the STOP technique to help with reactivity:

STOP technique. This stands for Stop, Take a Breath, Observe, Proceed. First, stop what you're doing and take a deep breath. This helps to create some distance from the situation. Next, observe what is happening. Objectively notice current thoughts and feelings. Then I proceed with whatever you want to say or do next. This technique can help prevent immediate reactivity.

If you're the partner of a perfectionist, what steps can one take to maintain the relationship?

Healthy and honest communication is important in relationships. This means communicating both the good and the bad in order to make sure all needs are being met.

My girlfriend is often anxious about her insecurities, not being good enough, and a bunch of other things. Best advice for a supporting partner that also doesn't want to feel like I'm in a constant caretaking role?

I really appreciate what others are saying about setting healthy boundaries. It can be hard to balance being supportive without being overwhelmed in a caretaking role. It can also be hard to encourage someone to reach out for therapy if they are not ready for therapy. They may respond defensively or with fear. It can feel really difficult to set boundaries – especially in close relationships.

Here are my general suggestions I offer when it comes to setting boundaries. It’s important to assess what your boundaries are and communicate them clearly with others. This likely will take some time and practice. There can also be a lot of guilt and fear that comes with setting boundaries. Sometimes people may feel like they are doing the “wrong thing” and that they are being “selfish.” Usually, when I am working with someone who feels this way we discuss how they can develop “healthy self-interest.”

Does hearing the stories/troubles of your patients affect your personal life?

Therapist burnout is real. In general, it’s so important for therapists to engage in their own self-reflection (and even personal therapy) and consult with colleagues to ensure that their own personal feelings and reactions aren’t impacting their work as a therapist. I would be lying if I said I have not been impacted by the pain that my clients have experienced. However, through my own growth as a therapist, peer consultation, and supervision, I have learned how to practice my own self-care and create healthy boundaries between my work/personal life. It’s also really important for me to be able to take care of my own feelings because if a client felt that I was overwhelmed by what they were experiencing then they might feel the need to become a caregiver towards me – and that’s definitely not what therapy should be.

Is it possible for someone to be a perfectionist with certain things but not others? I feel that I focus a lot of attention on things I can do well and so I expect perfection from myself, but in doing so I procrastinate doing anything I’m not adept at.

Is it possible for someone to be a perfectionist with certain things but not others? I feel that I focus a lot of attention on things I can do well and so I expect perfection from myself, but in doing so I procrastinate doing anything I’m not adept at.

Absolutely. There are varying degrees of perfectionism and it presents itself differently for everybody. A lot of perfectionists avoid tasks that they know they aren’t necessarily good at because they don’t want to face failure or don't want to feel like they aren’t good enough. They also may procrastinate for the same reason. There is a psychological concept called “confirmation bias.” People typically try to do things to confirm their beliefs about themselves. Sometimes being a perfectionist becomes such a huge part of an individual's identity and it's the role they've always had. It can feel extremely uncomfortable to challenge this.

Heres my resource: https://dictionary.apa.org/confirmation-bias

At what point is pharmaceuticals necessary to mitigate problems related to anxiety? I realize this is a terribly subjective question depending on the person but is there like a gamut of things a patient will normally try before determining that meds are needed?

I love subjective questions. It seems like most questions in psychology are subjective and depend on the specific situation. :)

As a psychologist, I am not able to prescribe medications. However, I always encourage my clients to seek consultation with a psychiatrist to evaluate their need for medication. It’s really important to me to work collaboratively with the psychiatrist to assess any potential side effects and discuss how the medication is impacting my client.

Sometimes meds are needed to help ease the therapy process – especially with anxiety which can be so physiologically based. The meds can help ease some of the more immediate distressing symptoms which can then help the individual go deeper into the root of the problem and address other underlying issues in therapy.

How can I learn to be kinder to myself? This is one that I am still learning and processing.

I am biased, but I recommend reaching out to a therapist. :)

One technique that I've worked on with individuals to help increase self-compassion and self-kindness is practicing a "loving-kindness meditation." There are TONS of these featured on youtube. Here is a version I recorded a while ago: https://www.youtube.com/watch?v=wJpV0bt9ink&t=335s

What are your thoughts on the saying “perfectionism is the playground of the abandoned child”?

perfectionism is the playground of the abandoned child”?

Yes, that can definitely sound accurate at times. Sometimes perfectionism can result from complex trauma and feeling emotionally abandoned.

How does your work relate to ASD, or do you often work with those on the spectrum?

I am not an expert on working with people diagnosed with Autism Spectrum Disorder. I have worked with teenagers diagnosed with ASD in the past and I loved it. I really appreciated their honesty with me and even their critique of the therapy process. From what I've learned, I know there is a tendency for an individual diagnosed with ASD to have perfectionistic traits and to work to get things "just-right" which often leads to immense frustration because of how difficult it can be to get there. I'm sorry that I don't have more to share!

First off, hi Morgan! We went to school together, I'll PM you so you know who I am, since this is my general use reddit account, but I wanted to pop in because I saw you were doing this, then found this post and wanted to offer my expertise.

I work with "high functioning" (not a term used in the field, but am using it here, generally this refers to cognitive functioning not ADS symptoms when I use it) kiddos with ASD and co-morbid depression, anxiety, trauma, etc. Working with these kids is not all that different from working with a neurotypical population. Often times their anxiety and depression can present very similarly, but may magnified because of ASD related symptoms (e.g., perseverations, literal understanding of language, repetitive thinking patterns). When teaching CBT skills, I work to make things as concrete and manipulative as I can. So instead of maybe simply discussing techniques like cognitive restructuring, relaxation, thought-felling-behavior connections, or emotion recognition, I have toys, games, and activities we do together to help them understand these concepts. You ultimately have to do more practice, break things down even more, and make things more concrete to help them stick. And at times you may explain something as "Just the way it is" when there are no more effective ways to get a message across (e.g., why you cannot make certain comments to others, engage in certain behaviors).

Hi there! Thank you so much for providing your insight here!

Is there a relationship between being overly praised or categorized as "gifted" as a child and future perfectionism/anxiety?

Is there a relationship between being overly praised or categorized as "gifted" as a child and future perfectionism/anxiety?

Yes, there is! It's theorized that it becomes part of the identity.

https://www.amazon.com/Drama-Gifted-Child-Search-Revised/dp/0465016901

Can you describe the difference between perfectionism and ocd?

Would love an answer to this as a perfectionist with OCD. Also how can I help my child not be like me?

I don't specialize in child psychology; however, here is an article with some helpful tips on children's self esteem: https://kidshealth.org/en/parents/self-esteem.html

Can you describe the difference between perfectionism and ocd?

Perfectionism is considered a personality trait and OCD (Obsessive Compulsive Disorder) is a label for a disorder.

Here is a link to an article that may be helpful: https://health.clevelandclinic.org/whats-the-difference-between-perfectionism-and-ocd/

I hope this helps!

What would you say to people whose perfectionism is... useful and beneficial? I would not have progressed nearly as far in my career (hit $500k/yr last year) without always trying to push everything and everyone around me to be better.

Nevertheless I have to medicate rather heavily (marijuana/melatonin) in order to sleep because work and other tasks/plans keep running in my head.

Perfectionism can definitely be useful and beneficial. When I work with individuals, we don’t necessarily work on “getting rid” of the perfectionism, but rather reflecting and adjusting how it impacts other areas of their life so that it doesn’t become detrimental and destructive. Overthinking and having poor work/life boundaries is definitely a common theme that I’ve seen. For these individuals, I would suggest assessing how pervasive the perfectionism is in their life and maybe even reaching out to a therapist to help them to learn how to create more of a balance.

what practical techniques do you think are better to deal with a crisis?

I guess it depends on what you mean by crisis. In an immediate crisis where there is risk involved, it’s important to either call 911 or go to your local emergency room.

In terms of times where someone may be experiencing high levels of anxiety, it can be helpful to work on and learn healthy coping strategies. A technique commonly worked on in therapy is the ability to self-soothe. This can look different for everyone.

One of my favorite techniques to help with a lot of distress in the moment is focusing on the senses. This involves focusing on what you see, hear, taste, feel, and smell. Focusing on the senses can be a helpful grounding technique.

Also, it’s important to keep in mind that it can be REALLY difficult to remember to use these strategies in a high stress situation. I typically recommend practicing these strategies and techniques when calm in order to gain practice with them and to become more used to implementing them.

I also recognize that someone may be in so much emotional pain that these techniques feel like they can't even make a dent. I would strongly encourage anyone feeling this way to reach out for help with a mental health provider.

What's the most surprising thing you've learned about perfectionism since you began your study of it?

I've been thinking and reflecting on this question for a few hours now. I think what I reflect on the most is how easy it is for us to see people who on the surface look like they have it all together, but are actually really struggling internally. Maybe this isn't the most surprising thing, but it definitely is something that sticks out to me. We never really truly know what somebody is experiencing and their story. As a therapist, it really is an honor (cheesy - I know) to be able to go deep into individuals stories.

What is the best advice you would give to someone with panic disorder?

I would recommend seeking out a mental health provider that specializes in treating panic disorder. There is strong research supporting the use of Cognitive Behavioral Therapy to treat panic disorder. From my understanding, there is a strong success rate.

What made you specialize in anxiety and perfectionism?

Also thank you for doing this AMA, it's such an interesting read and I find myself understanding and gaining perspective.

Early on in my training I paid attention to when I felt like I was doing my best work as therapist - I noticed that this occurred when I was working with individuals to find the underlying root cause behind their feelings and exploring their stories with them. Usually, anxiety and fear, is behind a lot of these struggles.

And thank you! I'm glad that you are finding this AMA helpful!

I recently experienced a traumatic event where a former best friend shot me twice. What are some positive coping techniques to learn to trust people again?

I'm so sorry to hear that. Trust can be really fragile and experiencing severe betrayal is painful. I would recommend reaching out to a mental health professional for support.

So, r/DrMorganLevy How good are you with dog anxiety for a two year old puppy who has had his entire family with him at home for over a year?

Oh gosh, all these puppies are going to be so upset when remote working ends! I wish I had the answer!

Have you ever read "Speaker for the Dead" by Orson Scott Card? I ask because there's a character that is super interesting who's personality/story relates specifically to what you know. I'd love to hear your take on her

I have not! I will add this to my list of books to read. Thanks for the rec!

Do you believe CPTSD is real, and are there specific treatments for it that are different than those for PTSD, anxiety, perfectionism?

I love this question. It's such an important one. Absolutely. Complex PTSD is real and should be treated differently than PTSD.

Treatment of PTSD is usually in response to a single traumatic event. It typically involves exposure-based interventions.

Treatment of C-PTSD is in response to someone experiencing severe distress and prolonged trauma over time. If someone grows up having so many of these bad experiences it is also likely that they did not have the experiences that taught them effective coping. For example, they may have difficulty regulating emotion, self-soothing, communicating effectively, identify needs/feelings, etc. Treating someone with C-PTSD with treatments established for PTSD can have a deteriorating effect.

Here is a resource: https://jri.org/services/behavioral-health-and-trauma/trauma-center

Thank you for the post. How do advise to let go from work after work? And what is your general approach to treating people with perfectionism?

Thank you for the post. How do advise to let go from work after work? And what is your general approach to treating people with perfectionism?

It can definitely be more difficult now when people are working from home. Also, it can take time to adjust to setting boundaries and separating work from personal life. In addition to setting boundaries (e.g., having clear work hours, learning when to say no) it can be helpful to practice mindfulness techniques to aid in the practice of letting go. There are so many different mindfulness and meditation techniques all over the internet so I typically recommend exploring different options to see what resonates personally. When it comes to the concept of letting go, this is one of my favorite youtube videos https://www.youtube.com/watch?v=vzKryaN44ss. It can also be helpful to schedule personal time and place just as much importance on that part of the schedule as you would with work.

I generally take an approach with my clients to understand where the perfectionism originated, why it originated, and how it is impacting their life and patterns now. That insight is then used to help create changes to live a more balanced life.

What do you suggest for a person to find the motivation to re-engage in creative endeavors? I had always been involved in the arts, it has been years since I've finished any artwork that takes an effort.

I have seen this SO often working with perfectionists. Usually it is with the individuals that are so burned out from their work that they don't have the energy to engage in any other activity that uses their brain (they like to just lounge and scroll on their phone or watch TV). Typically, we would work on create a more balanced schedule so that work isn't eating up all their energy. It could also be that fear of failure that is showing up that I've mentioned in other comments. When someone has that pattern of trying to be perfect they have a hard time letting go and relaxing. They also may constantly overthink and criticize themselves while being creative. In this scenario, I would suggest practicing mindfulness while engaging in the creative activity. Just recognize the thoughts, feelings, sensations that are coming up without judgment or criticism. AND if those thoughts do come up, don't push them away. Just acknowledge that they are there and let them be. I am going to link the mindfulness video that I find so helpful again: https://www.youtube.com/watch?v=vzKryaN44ss&t=1s

I teach AP Psychology and a lot of students are really struggling this year with their anxiety, grade perfection and depression. What advice would you give them?

Those AP classes are hard work! It must be even more difficult during this pandemic when there's increased isolation and anxiety. It's important to remember that it might not be a good idea to hold ourselves to the same standards we would pre-pandemic! Our outside world definitely has an impact on our ability to function.

I would also suggest that the students not be afraid to reach out for support from a trusted adult and even ask for help from mental health professionals at school.

Is anxiety genetic?

In general, anxiety disorders are complex and there usually isn't just one cause. The causes likely include a combination of factors such as biological, developmental, genetic, and environmental factors.

What are your qualifications?

I have my PhD in clinical psychology and am a licensed psychologist.