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Emergent Themes in the Writing of Perfectionists

Permanent Link: http://ufdc.ufl.edu/UFE0021585/00001

Material Information

Title: Emergent Themes in the Writing of Perfectionists A Qualitative Analysis
Physical Description: 1 online resource (84 p.)
Language: english
Creator: Merrell, Robert S
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2007

Subjects

Subjects / Keywords: aps, clinical, college, consensual, coping, disclosure, emotional, erlebnis, expectations, expressive, maladaptive, perfectionism, performance, psychotherapy, qualitative, research, stress, student, writing
Psychology -- Dissertations, Academic -- UF
Genre: Psychology thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The current study used the consensual qualitative research methodology to analyze the writings of 14 maladaptive perfectionists, as classified by the Almost Perfect Scale-Revised. This study is a component of a larger program of research aimed at testing the efficacy of adjuncts to shorter- or longer-term psychotherapeutic and psychoeducational interventions for maladaptive perfectionists. In what might best be categorized as an initial step toward uncovering the therapeutic potential of expressive writing for treating perfectionism, the current study utilized an emotional writing prompt to penetrate the inner world of maladaptive perfectionists. What did maladaptive perfectionists choose to share when prompted to write about their deepest feelings regarding stress, perfectionism, performance expectations, and coping? A more thorough understanding of such themes may enrich clinical interventions and inform the creation of subsequent measures or adjuncts to psychotherapy. Clinical implications and directions for future research are discussed.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Robert S Merrell.
Thesis: Thesis (M.S.)--University of Florida, 2007.
Local: Adviser: Rice, Kenneth G.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2009-12-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2007
System ID: UFE0021585:00001

Permanent Link: http://ufdc.ufl.edu/UFE0021585/00001

Material Information

Title: Emergent Themes in the Writing of Perfectionists A Qualitative Analysis
Physical Description: 1 online resource (84 p.)
Language: english
Creator: Merrell, Robert S
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2007

Subjects

Subjects / Keywords: aps, clinical, college, consensual, coping, disclosure, emotional, erlebnis, expectations, expressive, maladaptive, perfectionism, performance, psychotherapy, qualitative, research, stress, student, writing
Psychology -- Dissertations, Academic -- UF
Genre: Psychology thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The current study used the consensual qualitative research methodology to analyze the writings of 14 maladaptive perfectionists, as classified by the Almost Perfect Scale-Revised. This study is a component of a larger program of research aimed at testing the efficacy of adjuncts to shorter- or longer-term psychotherapeutic and psychoeducational interventions for maladaptive perfectionists. In what might best be categorized as an initial step toward uncovering the therapeutic potential of expressive writing for treating perfectionism, the current study utilized an emotional writing prompt to penetrate the inner world of maladaptive perfectionists. What did maladaptive perfectionists choose to share when prompted to write about their deepest feelings regarding stress, perfectionism, performance expectations, and coping? A more thorough understanding of such themes may enrich clinical interventions and inform the creation of subsequent measures or adjuncts to psychotherapy. Clinical implications and directions for future research are discussed.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Robert S Merrell.
Thesis: Thesis (M.S.)--University of Florida, 2007.
Local: Adviser: Rice, Kenneth G.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2009-12-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2007
System ID: UFE0021585:00001


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1 EMERGENT THEMES IN THE WR ITING OF PERFECTIONISTS: A QUALITATIVE ANALYSIS By ROBERT S. MERRELL A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE UNIVERSITY OF FLORIDA 2007

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2 2007 Robert S. Merrell

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3 To Lisa, Mom, Dad, and Jeff.

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4 ACKNOWLEDGMENTS I thank Amy, Joey, and Matt for their subs tantial contributionsboth intellectual and temporalto this project. To be sure, this project would not have been possible without the immense support and guidance of my mentor, Dr. Ken Rice. Lastly, this acknowledgment would not be complete without recognizing the steadfast encouragement of Lisa, whom I thank deeply.

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5 TABLE OF CONTENTS page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF TABLES................................................................................................................. ..........7 ABSTRACT....................................................................................................................... ..............8 CHAPTER 1 INTRODUCTION................................................................................................................... .9 2 LITERATURE REVIEW.......................................................................................................15 Conceptualizations of Perfectionism......................................................................................16 Adaptive and Maladaptive Perfectionism.......................................................................20 Treatment of Perfectionism.............................................................................................22 Expressive Writing............................................................................................................. ....24 Consensual Qualitative Research...........................................................................................29 Prior Qualitative Res earch on Perfectionism..........................................................................31 Present Study.................................................................................................................. ........35 3 METHOD......................................................................................................................... ......37 Participants................................................................................................................... ..........37 Researchers.................................................................................................................... ..38 Researcher Biases and Expectations...............................................................................39 Measures....................................................................................................................... ..........41 Procedure...................................................................................................................... ..........42 Selecting Participants......................................................................................................42 Training of the Research Team.......................................................................................43 Data Analysis.................................................................................................................. .44 Identification of domains.........................................................................................44 Abstracting core ideas..............................................................................................45 Auditing of domains and core ideas.........................................................................46 Cross-analysis...........................................................................................................46 Summary........................................................................................................................ .........47 4 RESULTS........................................................................................................................ .......49 Stress......................................................................................................................... ..............49 Coping......................................................................................................................... ............50 Expectations................................................................................................................... .........50 Social......................................................................................................................... .............52 Perfectionism.................................................................................................................. ........53 Variant Domains................................................................................................................ .....54

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6 Composite Vignette of a Typical Particip ant Derived from the Cross-Analysis....................55 5 DISCUSSION..................................................................................................................... ....56 Stress, Expectations, Perfectionism, and Coping...................................................................56 Clinical Implications.......................................................................................................... .....60 Limitations and Directions for Future Research.....................................................................63 Concluding Remarks............................................................................................................. .68 APPENDIX A MEASURES....................................................................................................................... ....71 B CATEGORY FREQUENCIES..............................................................................................74 LIST OF REFERENCES............................................................................................................. ..75 BIOGRAPHICAL SKETCH.........................................................................................................84

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7 LIST OF TABLES Table page B-1 Summary of domains and categories from the analysis of 14 expressive writing transcripts.................................................................................................................... .......74

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8 Abstract of Thesis Presen ted to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Master of Science EMERGENT THEMES IN THE WRITING OF PERFECTIONISTS: A QUALITATIVE ANALYSIS By Robert S. Merrell December 2007 Chair: Kenneth G. Rice Major: Psychology The current study used the consensual qual itative research met hodology to analyze the writings of 14 maladaptive perfectionists, as cl assified by the Almost Perfect Scale-Revised. This study is a component of a larger program of research aimed at testing the efficacy of adjuncts to shorteror longe r-term psychotherapeutic and psyc hoeducational interventions for maladaptive perfectionists. In what might best be categorized as an in itial step toward uncovering the therapeutic potential of expressive writing for treating perfectionism, the cu rrent study utilized an emotional writing prompt to penetrate the in ner world of maladaptive perfec tionists. What did maladaptive perfectionists choose to share when prompted to write about their deepest feelings regarding stress, perfectionism, performance expectations and coping? A more thorough understanding of such themes may enrich clinical interventions an d inform the creation of subsequent measures or adjuncts to psychotherapy. Clinic al implications and directions for future research are discussed.

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9 CHAPTER 1 INTRODUCTION With as many as 66% of some college populations categorized as perfectionists (Grzegorek, Slaney, Franze, & Rice, 2004), it is perhaps not surprisi ng that research on the topic has burgeoned in recent years. A preponderance of evidence points to th e multidimensionality of perfectionism (Frost, Heimberg, Holt, Mattia & Neubauer, 1993; Rice, Asbhy, & Slaney, 1998; Rice & Slaney, 2002; Slaney, Ashby, & Trippi, 1995) and from this heterogeneity, two salient higher-order dimensions emerge: one adaptive, the other maladaptive. Although similarities exist between adaptive and mala daptive perfectionists as oppos ed to non-perfectionists with respect to their relatively high personal performance standards and expectations (Dickinson & Ashby, 2005; Grzegorek et al., 2004; Parker, 1997; Rice & Mizradeh, 2000), maladaptive perfectionists typically demonstr ate higher levels of intense a nd persistent self-criticism, excessive concerns about making mistakes, and an enduring sense of inadequacy regarding their ability to attain desired goals (Rice, Bair, Castro, Cohen, & Hood, 2003). In fact, maladaptive perfectionists appear primed to perceive failure and to experience mistakes as distressing, in addition to having low self-esteem and feeli ngs of inferiority (Ashby & Kottman, 1996; Ashby, Kottman, & Stolz, 2006; Ashby, LoCicero, & Kenny, 2003; Rice & Dellwo, 2001; Rice & Slaney, 2002). Thus, it stands to reason that ma ladaptive perfectionism has been consistently associated with a variety of psychological disturbances, ranging from obsessive-compulsive disorder (Frost & Steketee, 1997) to suic idal ideation (Beevers & Mille r, 2004). Not only is perfectionism rampant but it is at tim es destructive. For instance, in recounting the suicides of three ostensibly successful indi viduals, Blatt (1995) persuasively attributed the deaths to what he termed intense perfecti onism (p. 1003). On a less lethal but no more optimistic note, because maladaptive perfectioni sm often plays a role in causing torment and

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10 anguish in young people who are striving to r each unattainable goals (Halgin & Leahy, 1989, p. 222), it behooves researchers to develop effec tive methods of combating perfectionisms insidious effects (Pacht, 1984, p. 387). Howeve r, few studies have examined therapeutic interventions targeting perfectionism and its concomitant maladjustment. Our understanding of the treatment of perfec tionists stems principally from secondary analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP) and a handful of othe r studies dealing with the treatment of eating disorders and obsessive-compulsive disorder (B latt, 1995; Blatt, Zuroff, Bondi, Sanislow, & Pilkonis, 1998; Zuroff et al., 2000). In a wo rd, the findings are bleak. Beyond exposing the mutual dissatisfaction with treatment gains for perfectionists and therapists alike, the research suggests that perfectionism mars the therapeutic alliance and d ilutes the impact of standard psychological interventions, in effect causing thera py to be less profitable for perfectionists than for non-perfectionists. Accordingly, Blatt (1995 ) has suggested that perfectionists may require longer-term, intensive in terventions: a recommendation that opposes the current emphasis on shorter-term and problem-focused psychotherapies. Thus, the present study is part of a larger program of research aimed at testing the effi cacy of adjuncts to s horteror longer-term psychotherapeutic and psychoeducational inte rventions for maladaptive perfectionists. Specifically, this study focuses on the identificati on of emergent themes in the writings of maladaptive perfectionists in response to a prom pt eliciting their deep est thoughts and feelings about stress, perfectionism, perf ormance expectations, and coping. Given that (a) persistent self-criticism a nd debilitating concerns about committing errors make the maladaptive perfectionist a likely candi date for psychotherapeutic intervention and (b) standard psychological treatment has proven to be less than adequate for addressing the concerns

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11 of maladaptive perfectionists, there is consequently a marked need to explore alternative therapeutic modalities. Expressi ve writing may be one such moda lity. Therapeutic writing (also termed the emotional disclosure paradigm) has i ndeed been prominent in contemporary research literature (see Bolton, Hewlett, Lago, & Wri ght, 2004; Lepore & Smyt h, 2002; Smyth, 1998), largely because of its enhancing influence on ph ysical and psychological health. Due to the possible applied utility of the written disclosure paradigm, research has focused on populations who may stand to gain from its clinical applic ation, ranging from individu als who recently lost employment (Spera, Buhrfreind, & Pennebaker, 1 994) to individuals diagnosed with either asthma or rheumatoid arthritis or cancer (Smyt h, Stone, Hurewitz, & Kaell, 1999; de Moor et al., 2002; Stanton et al., 2002; Walker, Nayle, & Croyle, 1999). Whereas the findings broadly suggest that adherence to the expressive writi ng prompt is associated with generally positive mental and physical health outcomes, there re mains a lack of consensus on why it works and with whom the expressive writing paradigm is most beneficial (Sloan &Marx, 2004). Conceivably, maladaptive perf ectionists may benefit from ex pressive emotional writing. In what might be thought of as a preliminary st ep toward uncovering the th erapeutic potential of expressive writing for perfectionism the current study utilizes an emotional writing prompt as an evocative instrument with which to penetrate th e inner world of maladaptive perfectionists. More specifically, the present investigation wi ll extend the perfectionism literature by identifying salient themes in the emotionladen written responses of mala daptive perfectionists. For instance, what will maladaptive perfectionists choose to elaborate on when prompted to share their deepest feelings about stress, perfectionism performance expectations, and coping? Which topics will they choose more fre quently? Conversely, which topics will respondents avoid? Awareness of these themes may enrich clinical interventions and lead to the creation of

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12 subsequent measures or adjuncts to psychotherapy (e.g., topic-fo cused therapeutic writing tasks, psychoeducational resources). By better understandi ng the themes in the writings of maladaptive perfectionists, the possibility for providing more effective psychotherapy may be enhanced, as are the prospects of increasing client sa tisfaction and treatment adherence. A search of the literature yiel ded four published articles invol ving qualitative inquiries into the nature of perfectionism (Rice, Bair, Castro, Cohen, & Hood, 2003; Riley & Shafran, 2005; Slaney & Ashby, 1996; Slaney, Chadha, Mobley, & Kennedy, 2000). That these studies capture a more personalized flavor of the construct is immediately apparent, as evidenced by the following quote from a participant of the Rice et al. (2003) st udy: Dont call me a perfectionistIt is like you wouldnt call an alcoholic a drunk to their [sic] face (p. 51). Accordingly, it is defensible that such quali tative inquires represent a powerful mechanism by which to extend the perfectionism literature. Nevertheless, extant qualitative literature on perfectionism is restricted by the scarce number of published studies and their attendant methodological cons traints. For instance, there are no studies devoted to the excl usive examination of maladaptiv e perfectionists. Although they admittedly were interested in a circumscribed form of perfectionism which they termed clinical perfectionism, Riley and Shafran (2005) may have best approximated having a homogenous sample of maladaptive perfectio nists, though their approach wa s guided by a theoretical bent toward examining the core psychopathology of clinical perfectionism (p. 369). Thus they restricted their focus to the psychopathologi cal presentation of pe rfectionism with an accompanying diagnosable disorder (e.g., anorexia nervosa, bulimia nervosa) (see Shafran, Cooper, & Fairburn, 2002, 2003) and thereby failed to account for maladaptive perfectionism as a more global personality orientation (Flett & Hewitt, 2002, p. 10). The other qualitative

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13 studies relied principally on selfor peer-identified pe rfectionists. An exception is the study by Rice and colleagues (2003), wherei n they performed join t qualitative and quantitative analyses. The qualitative portion did examine clearly de lineated adaptive-, ma ladaptive-, and nonperfectionist clusters, yet the researchers a ffirmed that there were too few maladaptive perfectionists (4) and they thus recommended that future research should include larger groups. Of more substantive concern, only one of the pub lished studies known to the author (Rice et al., 2003) relied on a verifiable a nd rigorous qualitative methodology. Consequently, although prior qualitative research on perfectionism sheds light on more intimate aspects of the construct, an extra degree of caution may be warran ted when evaluating the findings. Given that the available literature may bene fit from studies rooted in more thorough qualitative approaches, the current study seeks to complement prior res earch by utilizing the consensual qualitative research paradigm (C QR; Hill et al., 2005; Hill, Thompson, & Williams, 1997), a qualitative methodology that is ideally suited to achieve the accurate and systematic identification of emergent themes within the writte n responses of maladaptiv e perfectionists. In consonance with the CQR methodology, a priori hypotheses are not generated in the current study in order to allow researchers to remain open to themes and ideas that emerge from the data. Without a priori hypotheses, researchers remain free to discover themes that may have been neglected prior to data collection (Heppner, Kivlighan, & Wampold, 1992). In sum, maladaptive perfectionism refers to personality characteristics such as persistent self-criticism, chronic and excessive concer ns about making mistakes, and a significant perceived gap between ones performance and exp ectations. That maladaptive perfectionism has been consistently linked with psychological maladjustment is not shocking. Unfortunately, traditional psychotherapeutic interventions have typically not been associated with positive

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14 treatment outcomes, leading some researchers to conclude that perfectionists may require longerterm, intensive interventions. Alternative ways of conceptualizing treatm ents are necessary, and the expressive writing paradigm not only coincide s with the zeitgeist of the managed care era but also holds much allure due to its establishe d efficacy in diverse treatment populations. An additional contribution of emoti onal writing is that it provides insight into the thoughts and feelings of the participant. A lthough qualitative research on perf ectionism exists, the corpus of studies on perfectionism is limited numeri cally and further limited by sample and methodological constraints. Continuing in the qualitative tradition, the present study identifies emergent themes in the emotionally rich written responses of maladaptive perfectionists, and the findings may (a) inform the creation of measures or adjuncts to psychotherapy and (b) bolster clinical interventions as well as client satisfaction and treatment adherence.

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15 CHAPTER 2 LITERATURE REVIEW The present study is a component of a larger program of re search aimed at testing the efficacy of adjuncts to shorteror longe r-term psychotherapeutic and psychoeducational interventions for maladaptive pe rfectionists. In particular, th e current project focuses on the themes to emerge when malada ptive perfectionists respond to an expressive writing paradigm that purports to elicit their d eepest thoughts and feelings about stress, perfectionism, performance expectations, and coping. T hus, the ensuing literature re view spans perfectionisms conceptualization, its association with psycholog ical difficulties, and its less than desirable amenability to treatment. Additionally, background research on the expressive writing paradigm is reviewed. This literature will be followe d by a review of the st udys chosen qualitative methodology, consensual qualitative research (CQR; Hill, Thompson, & Williams, 1997). Finally, prior phenomenological research on perfectionism will be presented in order to contextualize the present study within a corpus of related literature. This review will demonstrate the following key points: (a) perfectionism is a complex, multidimensional construct with adaptive and maladaptive features; (b) maladaptive perfectionism, which refers to personality characteristics such as persistent self-criticism, chronic and excessive concerns about making mistakes, and a significant perceived gap between ones performance and expectations, has been associated with various psychological difficulties and a lack of amenability to treatment; (c) the expressi ve writing paradigm may be used as a powerful instrument to uncover the thoughts and emotions of maladaptive perfectio nists; (d) CQR is a qualitative methodology that is ideally suited to achieve the accurate and systematic identification of emergent themes within the writ ings of maladaptive perf ectionists; and (e) prior qualitative research on perfectionism capture s nuances of the cons truct undetected by

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16 quantitative methodologies and thus represents an alluring appro ach to expand the perfectionism literature. Conceptualizations of Perfectionism As evidenced by the recent exponential growth of publications on perfectionism (see Flett & Hewitt, 2002a), the construct has received much attention in recent academic literature. Consequently, extensive reviews of the topic (Fro st, Marten, Lahart, & Rosenblatt, 1990; Hewitt, Flett, Besser, Sherry, & McGee, 2003; Shafran & Mansell, 2001) demonstrate that researchers vary in their definitions of perfectionism. In or der to distinguish between conceptualizations of perfectionism, researchers have focused on the constructs underlying dimensionality. Unidimensional and multidimensional approaches have been developed. First, this review will briefly examine the unidimensional perspective in order to better appreciate the historical evolution of perfectionism research. Then, th is arguably restrictive line of inquiry will be followed by a review of the more comprehens ive and empirically supported multidimensional approach. Characterizing perfectionism negatively and linking it with forms of psychopathology (Burns, 1980; Garner, Olmstead, & Polivy, 1983; Pacht, 1984), the unidimensional perspective historically held sway over pe rfectionism research (Stoeber & Otto, 2006). Despite Hamacheks (1978) seminal article proposing tw o distinct (normal and neurotic ) forms of perfectionism, the prevailing view of the 1980s centered on perfecti onisms dysfunctional aspects. Largely driven by a focus on cognitive factors, the unidimensi onal view emphasized irra tional beliefs (Ellis, 1962) and dysfunctional attitudes (Burns; Weisma n & Beck, 1978). This narrow attention on the negative determinants/concomitants of perfectio nism was reflected in the one-dimensional measures used to assess perfectionism, such as the perfectionism subscale of the Eating Disorders Inventory (Garner et al .) and Burns perfectionism s cale which contained items from

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17 Weissman and Becks Dysfunctional Attitudes Scal e. Because most of the studies relied on these decidedly dysfunctionally attuned measur es (see Stoeber & Otto), empirical findings supported the view that perfectioni sm was uniquely negative in vale nce; as stated by Stoeber and Otto, it comes as no surprise that perfectioni sm was found to be negative, dysfunctional, and even pathological (p. 3). Therefore, in order to capture the fullness of perfectionism researchers turned toward multidimensional approaches. According to Flett and Hewitt (2002b), the em pirical demonstration of perfectionisms multidimensionality may be one of the most significant developments in this field of research. It is noteworthy, however, that this perspective is not w ithout its detractors: Shafran, Cooper, and Fairburn (2002, 2003) are recent proponents of perfec tionism as a unitary c onstructor at least they may appear to be initially. It is equally noteworthy that their position is related specifically to what they term clinical perfectionism, or perf ectionism as a circumscribed clinical construct (2003, p. 1218). Thus, they restrict their argumen t to the psychopatholog ical presentation of perfectionism with a concomitant diagnosable diso rder (e.g., anorexia nervosa, bulimia nervosa). Shafran and colleagues are necessarily limiting thei r unidimensional stance by claiming that such unidimensionality is not relevant to perfectionism as a personality orie ntation (Flett & Hewitt, 2002b, p. 10). In short, Shafran et al.s a pparent opposition to the multidimensionality of perfectionism is bounded by their clinical perspectiv e, and thus serves to exemplify but one of perfectionisms multiple dimensions. Because of perfectionisms inherent comple xity, multidimensional approaches allow for a richer understanding of the construct, an unders tanding which eludes unidimensional analysis. The following three multidimensional measures of perfectionism have influenced recent research: two Multidimensional Perfectionism Scales, with each qualified by its respective

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18 authors names (FMPS; Frost, Martin, Laha rt, & Rosenblate, 1990; HMPS; Hewitt & Flett, 1991), and a third measure entitled The Almost Perfect Scale-Revised (APS-R; Slaney, Rice, Mobley, Trippi, & Ashby, 2001). Although both Mu ltidimensional Perfectionism Scales assess (a) the respondents adherence to very high personal standard s and (b) the degree to which external factors contribute etiologically to perfectionism (i.e., Parental Expectations and Parental Criticism in the FMPS and Socially Prescribed perfectionism in the HMPS), the scales nevertheless vary substantially in their approach es to conceptualizing perfectionisms underlying dimensionality. The FMPS relies on 6 dimensions of perfectionism: (a) Pe rsonal Standards, (b) Organization, (c) Concern over Mistakes, (d) Doubt s about Actions, (e) Parental Expectations, and (f) Parental Criticism. Hewitt and Flett, on the other hand, identify three chief aspects of perfectionism: (a) Self-oriented perfectionism, re ferring to the inclination to set high standards for oneself, (b) Socially-prescribed perfectionism wherein one believes that others impose high standards, and (c) Other-oriented perfectionism, referring to the in clination to set high standards for others. Whereas attempting to reconcile the divergen t conceptualizations of perfectionism as embodied in the FMPS and HMPS is clearly beyond the scope of this review, it is nevertheless critical to point out that various independent analyses of the meas ures suggest that perfectionism has both adaptive (or healthy) and maladaptive (o r dysfunctional) aspects. For instance, two conceptually unambiguous fact ors emerged from a factor analysis performed by Frost, Heimberg, Holt, Mattia, and Neubauer (1993, p. 124): one which they named Maladaptive Evaluations Concern and another they termed Positive Striving. Thus, the multidimensional approach yields a more comprehensive and rich er view of perfectionism, a claim which also

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19 holds true with the third princi pal instrument used to define and measure perfectionism: the APSR (see Appendix A). The APS-R (Slaney, Rice, Mobl ey, Trippi, & Ashby, 2001), whic h is the revised version of its predecessor, the Almost Perfect S cale (Slaney & Johnson, 1992), conceptualizes perfectionism in three dimensions: (a) High Standa rds, (b) Order, and (c) Discrepancy, or the degree of distress experienced when ones perceived performance falls short of ones perfectionistic expectations. The former subscal es are potentially adaptive dimensions, whereas the latter is likely negative. A benefit of the APS-R is the addition of the Discrepancy subscale, which addresses this gap between perceived perf ormance and expectations and thus stands to supplement research on perfectionism. Via the Discrepancy subscale, the APS-R gains in creased ability to adequately differentiate between adaptive versus maladaptive (or healt hy versus unhealthy, norm al versus neurotic) perfectionism. Nonetheless, there is a lack of consensus regardi ng this position. Most strikingly, Flett and Hewitt (2002b), defending their position th at definitions of perfectionism should be limited to perfectionistic strivings, argue that pe rceived discrepancies should be considered a component of a related yet ultimat ely separate construct that hi ghlights self-evaluation. They contend that discrepancy is more vulnerable to temporal factors (e.g., ongoing shifts in performance feedback, changing life experiences), and that, as a relativ ely stable personality construct, perfectionism should remain largely unaffected by su ch vicissitudes. What their viewpoint fails to account for, how ever, are the intrinsic tendencies, constraints or expectations that exert substantial influence on how a perfectionistic individual interprets such elements in flux. It seems tenable that how the perfectioni stic individual responds to such variability, however, cuts to the core of perf ectionism as a relatively stable personality construct. Inclusion

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20 of the discrepancy subscale addresses this gap between perceived perfor mance and expectations and thereby enhances research on perfectionism. In fact, Rice and Aldea (2006) recently found that perfectionistic discrepancy a ppears to have substantial relative stability, which refers to the extent to which relative differe nces among individuals on measures of personality remain stable (Santor, Bagby, & Joffe, 1997, p. 1355). They also found that the stability was maintained in spite of mood fluctuations. Additionally, Stoebe r and Otto (2006) emphasize that discrepancy is a core facet of perfec tionism and, consequently, one that should be considered when distinguishing between types of perfectionism, a point which will be elaborated on shortly. Adaptive and Maladaptive Perfectionism Thus, advances in the way in which perfectio nism is conceptualized, as embodied in the three preceding measures that dominate current perfectionism research, have led to a more thorough understanding of the c onstruct. As a result, two higher-order dimensions of perfectionism have emerged, each with its uniqu e relationship to functioning: one variously referred to as adaptive, healthy, normal or personal standards perfectionism; and another termed maladaptive, unhealthy, or neurotic perfectionism. Cluster analysis has been used in several studi es to segment participants into one of three groupings: adaptive perfectionist, maladaptive perf ectionist, or non-perfecti onist. Similarities exist between adaptive and malada ptive perfectionists as opposed to non-perfectionists, with particular resemblance in their relatively high personal performance sta ndards and expectations (Dickinson & Ashby, 2005; Grzegorek et al., 20 04; Parker, 1997; Rice & Mizradeh, 2000). Adaptive and maladaptive perfectioni sts also tend to resemble one another in terms of internal locus of control (Periasamy & Ashby, 2002). Mala daptive perfectionists typically demonstrate higher levels of intense and pers istent self-criticism, excessive concerns about making mistakes, and an enduring perceived sense of inadequacy a nd ability to attain desi red goals (Rice et al.,

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21 2003). Adaptive perfectionists, conversely, tend to have high personal standards and also pursued performance excellence, yet their experi ence appears notably devoid of disproportionate self-castigation or chronic dissa tisfaction with their performan ce (Slaney, Rice, & Ashby, 2002). On a related note, adaptive perf ectionists tend to have higher se lf-esteem and self-efficacy, with both appearing impervious to the long-term dele terious effects of perc eived failures to meet standards (Ganske & Ashby, 2007; LoCicero & Ashby, 2000). Findings with particularly negative implications ar e of concern for maladaptive perfect ionists: they appear excessively primed to perceive failure and to experience mi stakes as distressing, in addition to having low self-esteem and striking feelings of infe riority (Ashby & Kottman, 1996; Ashby, Kottman, & Stoltz, 2006; Rice & Dellwo, 2001; Rice & Slaney, 2002) In light of the disparities between adaptive and maladaptive perfectionism, it is perhaps not surprising that maladaptive perfectionism has been consistently associated w ith a variety of psychologi cal disturbances. To summarize, maladaptive perfectionism refe rs to personality characteristics such as persistent self-criticism, chronic and exce ssive concerns about making mistakes, and a significant perceived gap between ones perf ormance and expectations. Personality characteristics involving harsh self-criticism and pe rformance-evaluation disparity have been consistently linked with nume rous indicators of psychological maladjustment, including obsessive-compulsive disorder (Frost & Stek etee, 1997), depression (A shby, Rice, & Martin, 2006; Dunkley, Sanislow, Grilo, & McGlashan, 2006; Rice & Aldea, 2006), chronic fatigue syndrome (White & Schweitzer, 2000), suicidal ideation (Beev ers & Miller, 2004), hopelessness (OConnor & OConnor, 2003; Rice, Leever, Chri stopher, & Porter, 2006), anxiety (Mobley, Slaney, & Rice, 2005; Rice & Pence, 2006), eatin g disorders (Lilenfeld, Wonderlich, & Riso,

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22 2006; Pearson & Gleaves, 2006), and insecure adult attachment (Rice, Lopez, & Vergara, 2005; Wei, Heppner, Russell, & Young, 2006; Wei, Ma llinckrodt, Russell, & Abraham 2004). Treatment of Perfectionism Although an abundant literature attests to the detrimental c onsequences of perfectionism, successfully treating such perfectionists has proven to be challenging at best and discouraging at worst. Only a few published studies (e.g., DiBartolo, Frost, Dixon, & Almovodar, 2001; Ferguson & Rodway, 1994) directly examine treatment interventions for perfectionists. This dearth of research may in pa rt be accounted for by the scant likelihood that one would present exclusively to confront her or his perfectioni sm. As expressed by Halgin and Leahy (1989), experienced mental health professionals know th at college students do no t seek treatment for perfectionism (p. 223). At any rate, few studi es exist regarding the direct treatment of perfectionism. Employing a cognitive-behavioral approach, Ferguson and Rodway (1994) attempted to treat features typically associat ed with perfectionism, such as self-criticism, difficulty dealing with feedback, unrealistic goa l setting, and procrastinati on. Although the participants demonstrated variable reductions in the perfectio nism, the authors concluded that the treatment was successful for eight of the nine participan ts. In a study on the effects of a brief cognitive restructuring intervention on speech anxiety for perfectionistic a nd non-perfectionistic undergraduate students, DiBartolo et al. (2001) found that although the treatment did not affect global ratings of negative affect or negative cognitions, cognitiv e restructuring was successful inasmuch as that all participants had reduced anxi ety and an increased ability to cope with their most feared predicted outcome. In effect, these studi es provide some preliminary support for the effectiveness of cognitive restructuring in the treatment of perfectionism, though other research is not so optimistic.

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23 Apart from the exceptions noted above, perfectionism has typically been investigated within the treatment of other presenting psychological issues, such as eating disorders and depression. Because perfectionism may be a risk factor for the development of eating disorders (e.g., Fairburn, Cooper, Doll, & Welch, 1999), resear chers have accordingly examined its role in this context. In their study on long-term recove ry from anorexia nervosa, Srinivasagam, Kaye, and Plotnicov (1995) found that pe rfectionistic characteristics remained with clients after otherwise successful treatment fo r eating disorders, thereby indi cating that alt hough the target symptoms may have diminished, chief contri buting factors to disordered eating may be impervious to therapeutic inte rvention. In a much broader sense, our understanding of the treatment of perfectionist s is based on secondary analyses of the National Institute of Mental Health Treatment of Depression Collaborative Re search Program (TDCRP) (Blatt, 1995; Blatt, Quinlan, Pilkonas, & Shea, 1995; Blatt et al., 1998; Zuroff et al., 2000) The findings are troubling. Specifically with the case of comorbid depression, perfectionism is linked with poorer outcomes post-intervention, regardless of treat ment modality (e.g., Blatt et al., 1995). Researchers concluded that perfectionism advers ely impacts treatment, damages the therapeutic alliance, and, not surprisingly, negatively influe nces relationships outsi de of therapy (Blatt & Zuroff, 2002). Consequently, psyc hotherapy appears to be less e ffective for perf ectionists than for non-perfectionists. For these reasons, some researchers have sugge sted that perfectionists may require longerterm, intensive interventions (see Blatt, 1992): a r ecommendation that runs counter to trends for shorter-term and problem-focused psychotherapi es. Of course, longer-term therapeutic approaches may indeed be warranted, however their implementation carries with it obvious economic and logistical challenges (see Penneba ker, 2004). At any rate, the limited extant

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24 research does not support the efficacy of typical therapeutic interventions for maladaptive perfectionists. In sum, persistent self-criticism and debilitating concerns about committing errors conspire to make the maladaptive perfectionist a prime candidate for psychotherapeutic intervention. Unfortunately, the relatively few studies that investigate this topic suggest that current approaches are less than satisfact ory. Thus, there is a pronounced need to explore alternative therapeutic modalities, and the sear ch may involve novel approaches in the interest of addressing perfectionisms documented lack of amenability to treatment. With this in mind, the review now focuses on the expressive writing paradigm, a pe rhaps powerful instrument to assist in the uncovering of the thoughts and emotions of mala daptive perfectionists. An examination of perfectionists writings may plau sibly inform future diagnostic procedures, measure, and courses of psychotherapy. Expressive Writing Derived principally from Pennebakers (1997) seminal work, expressive emotional writing (also termed the emotional disclosure paradigm) has been thoroughly researched for its influence on physical and psychological health. In the pr esent study, we utilize an expressive writing prompt to identify emergent themes in maladapt ive perfectionists responses. Not only could such writing constitute a free-st anding therapeutic strategy or a complement to psychotherapeutic approaches aimed at assisti ng perfectionistic individuals to optimize their functioning (Pennebaker, 2004), but identificatio n of salient themes may inform clinical interventions and the development of subsequent measures and adj uncts to psychotherapy (e.g., topic-focused therapeutic writing tasks, psychoeducational outr each programs). Thus, this section of the current review will (a) contextualize the emotiona l disclosure paradigm within the landscape of psychological literature, (b ) clarify how the paradigm is typi cally employed, and (c) demonstrate

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25 the generally beneficial outcomes associated with the paradigm. Moreover, it will become clear that the paradigm represents a powerful instrume nt with which to penetrate the inner world of maladaptive perfectionists. Whether rooted in psychoanalytic, humanistic, or behavioral traditions, nearly all forms of psychotherapy have been demonstrated to re duce stress and promote well-being (Mumford, Schlesinger, & Glass, 1983; Smith, Glass, & Mi ller, 1980). The therapeu tic process generally entails the acknowledgement and discussion of a problem, and as suggested by Pennebaker (1997), the mere aspect of disclosure is a powerful therapeutic agent that may account for a substantial percentage of the va riance in the healing process (p. 162). The value of emotional release has long been recognized within psychol ogical research and app lication (Smyth, 1998). In fact, psychologists have continually emphasized that emotional expression is critical to physical and mental health, wh ereas, conversely, inhibition has been considered detrimental (e.g., Breuer & Freud, 1895/ 1966; Rachman, 1980, Sc heff, 1979). More cu rrently, an increasing corpus of literature attests to the health-enhanc ing effects of emotional expression (e.g., Fawzy et al., 1993; Murray, Lamnin, & Carver, 1989; Pennebaker & OHeeron, 1984). Of particular value for its effectiveness and economic implications (see Pennebaker, 2004), writing paradigms have been utilized to evoke such emotional expression in several recent studies (Donnelly & Murray, 1991; LAbate, 1992; Lange, 1994; Murray & Segal, 1994). The typical expressive treatment condition in this re search involves participan ts writing about their deepest feelings about traumatic or stressful experiences (e.g., di vorce or separation from partner, illness, death of a l oved one, loss of job) for some circumscribed period of time (e.g., 20 or 30 minutes). These sessions occur once a day, us ually for three days, with one or more days separating sessions (see Sloan & Marx, 2004a, for methodological variation). In the control

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26 condition, participants follow the same writing sche dule as treatment participants, yet they write about an innocuous object or event, selected at their discretion, wit hout mentioningemotions, opinions, or beliefs (Penneba ker & Francis, 1996, p. 607). Because of the possible applied utility of th e written disclosure paradigm, research has centered around the following populati ons who may stand to gain from its clinical application, as noted by Sloan and Marx (2004a): individuals w ho recently lost employment (Spera, Buhrfreind, & Pennebaker, 1994), prison inmates (Richards, Beal, Seagal, & Pennebaker, 2000), individuals diagnosed with either asthma or rheumatoid arthritis or cancer (Smyth, Stone, Hurewitz, & Kaell, 1999; de Moor et al., 2002; Stanton et al., 2002; Walker, Nayl e, & Croyle, 1999), bereaved adults (Stroebe, Stroebe, Schut, Zeck & van den Bout, 2002), individuals preparing for an imminent entrance exam (Lepore, 1997), a nd individuals with a history of traumatic experiences (Batten, Follette Hall, & Palm, 2002; Gidron, Peri, Connonlly, & Shalev, 1996; Schoutrop, Lange, Hanewald, Duurland, & Bermond, 1997; Schoutrop, Lange, Hanewald, Davidovich, & Salomon, 2002). Whereas the partic ular details of these studies is beyond the scope of this review, Sloan and Marx conclude that the evidence largely suggests that adherence to the expressive writing prompt is associated with generally positive mental and physical health outcomes. However, the authors are quick to add th at in spite of writings effectiveness, there is a lack of consensus on why it works and with wh om the expressive writing paradigm is most conducive to attaining desired outcomes. Various perspectives abound on how expres sive writing catalyzes positive change. Although Pennebaker (1989) origina lly argued that inhibition of emotion acted as the primary mechanism of change associated with the wri tten disclosure paradigm, subsequent research suggests that the mechanisms for the therapeu tic effects are not yet clearly understood (e.g.,

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27 Pennebaker, 2004; Sloan & Marx, 2004a). Thre e prominent explanatory mechanisms dominate the literaturegrouped together under the gene ral rubrics of emotional inhibition, cognitive adaptation, and exposure/ emotional processingt hereby suggesting that th e written disclosure paradigm affects respondents on a variety of le vels (Sloan & Marx). Perhaps due to the ostensible breadth and depth of emotion and cognition evoked by the paradigm, a preponderance of research indicates that expr essive writing is indeed effectiv e, though the findings also suggest an increase in potentially negative (yet fleeting) outcomes. Smyths (1998) meta-analysis of 13 studies yiel ded a mean weighted effect size across all studies and outcomes of d = .47 ( r = .23, p < .0001), indicating a medium positive effect for participants in expressive writ ing conditions compared to contro l participants. These results were largely corroborated by Sloan and Marx, w ho examined 14 studies published after Smyths meta-analysis. It is noteworthy, however, that there may be an associ ation between increased heart rate and negative mood when measured immediately after the writing (i.e., pre-to-postwriting). Curiously, even though Smyths meta-ana lysis indicated a large effect size for these adverse implications ( d = .84), the link between immediate distress and later measured outcomes was not statistically significant. Research by Sloan and Marx (2004b) and Pennebaker (1997) qualifies the overall impact of in itial distress after a first writ ing session, with data suggesting that such distress (a) tends to diminish over s ubsequent writing sessions and (b) may in fact enhance later post-test effects. These findings carry methodological implications for expressive writing studies, such as the poten tial benefit of allowing time to lapse between the last writing session and the formal post-assessmen t of dependent variables. In sum, Pennebaker and colleagues (1997) have demonstrated that when people disclose painful or difficult emotions via expressive writin g, the disclosure is associated with a continuum

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28 of health-enhancing effects, ranging from an in creased sense of mental well-being (as evidenced by diminutions of perceived distress and depres sive symptoms) to improved functioning of the immune system (as evidenced by beneficial in fluences on t-helper cell growth and antibody responses to hepatitis B vaccina tions and Epstein-Barr virus). Because the written disclosure paradigm elicits such deep emotional material from its respondents, it affords a rich perspective on the inner world of the writer, revealing a privileged insight in to the individuals experience. According to Pennebaker, the writing session is exceptionally powerful[because] participants disclose a remarkable range and depth of trau matic experiencesIf nothing else, the paradigm demonstrates that when individua ls are given the opportunity to di sclose deeply pe rsonal aspects of their lives, they readily do so (p. 162). As briefly mentioned earlier, it is not uncommon to encounter themes related to unreq uited love, sexual and physical abuse, tragic failure, and death. Therefore, the emotional disclosure paradigm also represents an invaluable point of access into the thoughts and feelings of t hose individuals who may benefit from advances in psychological research. A search of the psychological literature yields no studies th at have examined the written responses of maladaptive perfecti onists. Conceivably, a more refi ned understanding of the inner world of maladaptive perfectionists, a group who does not respond well to typical psychotherapeutic interventions (B latt et al., 1998), may translate in to increased effectiveness of psychotherapy and/ or relevant ad juncts. To be sure, response s to the emotional disclosure paradigm would provide the material necessary to better identify the t houghts and feelings of maladaptive perfectionists, but how would one proceed in order to develop an accurate understanding of such rich information? With this in mind, the presen t review now focuses on

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29 CQR (Hill et al., 1997), a qualitative methodology id eally suited for the systematic identification of themes within the emotiona lly charged written responses of maladaptive perfectionists. Consensual Qualitative Research Qualitative methods denote a wide class of empi rical procedures designed to describe and interpret the Erlebnis (lived experience) of the research part icipants in a context-specific setting (Denzin & Lincoln, 2000). Embracing a decidedl y constructivist pers pective, qualitative researchers posit that objective r eality does not readily lend itself to full comprehension, and thus there exist multiple equally valid ways of studying reality (Heppner & Heppner, 2004). Specifically, qualitative approaches are ideally suited to explorator y phases of inquiry as they afford the ability to analyze data as naturally occurring phenomena. In the absence of a priori hypotheses, researchers are not co mmitted to clearly defined inve stigative routes and instead remain free to discover themes and ideas that ma y have been neglected prior to data collection (Heppner, Kivlighan, & Wampold, 1992). Although counseling psychologists in partic ular have been endorsing qualitative methodologies for some time (see Neimeyer & Re snikoff, 1982), North American psychology in general has been slow to embrace the para digm shift toward postmodern methodologies (Ponterotto, 2005), perhaps in part due to a dear th of sufficiently ri gorous methods. As an alternative to the imprecise or unwieldy methodologies available to counseling researchers, Hill, Thompson, and Williams (1997) developed CQR, an integration of the strongest features of existing qualitative methods (i.e., grounded theory, comprehensive process analysis, phenomenology; see Hill et al., 1997) that has subs equently become one of the most frequently utilized in counseling inquiry. Even though a more exhaustive depiction of CQR is included the methods section, the essential components follow, as summarized by Hill et al. (2005): CQR utilizes (a) open-ended

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30 questions in semi-structured data collection tech niques, (b) multiple judges in order to ensure various analytic perspectives, (c) consensus to ar rive at renderings on the meaning of data, (d) at least one auditor to check and challenge the work of the primary team and minimize the effects of groupthink; and (e) domains, core ideas, a nd cross-analyses in the data analysis. In order to extend the literature on perfectioni sm and refine the constructs meaning from a phenomenological perspective, this study will use CQR to gain a more sophisticated understanding of maladaptive perfectionists re sponses to the expressive writing paradigm. Thus, the expressive writing exercise replaces Hill et al.s (1997) suggestion to conduct interviews. In their review of 27 published studies that employed CQR, Hill et al. (2005) indicated that 14 studies used ta ped telephone interviews, 10 used taped face-to-face interviews, two used a paper-and-pencil survey format, and one used an e-mail format. Whereas each distinct method ha s its attendant asse ts and liabilities, use of the written disclosure paradigm appears valuable for the fo llowing reasons, at a minimum: the richness of the elicited material far exceeds the arguably t hin responses evoked by questionnaires (Hill et al., 1997); the process affords more anonymity than face-to face interviewsthough admittedly less than telephone interviewsand thereby redu ces the likelihood of participants providing responses on the basis of social desirabi lity (see Wiseman, 1972); and, although prone to engendering increased complexity and ambiguity for the researchers during the analytic process (see Hill et al., 1997), the openended question allows for the participant to respond freely, unencumbered by a questionnaire or even a set of preconceived inte rview questions. Of course, the mere existence of a question imposes a degree of structure, yet it is the respondent who interprets the direction in whic h to proceed.

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31 Clearly, the expressive writing paradigm constitutes a not me rely defensible but also profitable catalyst to provide researchers with emo tionally charged data to examine. At the heart of the analytic process is cons ensus, perhaps the fundamental i ngredient of CQR. The process hinges on having a multiplicity of perspectives, with the assumption that such an array of views increases the accuracy of data interpretation and reduces researcher bias es (Marshall & Rossman, 1989). In brief, CQR entails a process of consta ntly refining the data in terpretation based on the intrinsically diverse views of the research team. These views nece ssarily evolve as new cases are studied and team members argue to consensus about the coding of the data. Further checks and challenges are offered by external auditors w ho monitor the analytic process at strategic intervals. Hence, the process is sufficiently rigor ous in order to ensure th at the research develops a continually attuned focus. As noted by Pont erotto (2005), a 15-year methodological content analysis of the Journal of Counseling Psychology (1989 2003) revealed that CQR is one of the two most frequently used qualitati ve approaches incorporated in the journals published articles. In sum, it appears fitting that CQR is employed in the current study to ac hieve the accurate and systematic identification of emergent themes with in the writings of maladaptive perfectionists. Prior Qualitative Research on Perfectionism A search of the literature yiel ded four published articles invol ving qualitative inquiries into the nature of perfectionism. Slaney and Ashby ( 1996) maintained that clinicians and researchers typically define perfectionism. Such explanations, while not entir ely devoid of perfectionists perspectives, are fairly restricted to the pathologi cal side of the construct, in part due to negative set which may constrict the expert s conceptualization. In an e ffort to better understand the construct from the perfectionist s vantage point, these researchers identified and interviewed a criterion group of 37 individuals who either considered themselves to be perfectionists or were referred to the research team as a for sure perfectionist (p. 394) Most participants expressed

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32 the centrality of high personal standards to th eir perfectionism, a sa lient finding which was accompanied to a lesser degree by emphases on orde rliness and control. Curiously, even though participants frequently viewed th eir perfectionism as distressing, not one of those asked said they would abandon it. This reluctance to relinquish perfectionism may in part be attributable to other positive features that emerged, such as the driv e to achieve, as evident in one participants statements: Its a drive that pushes me to accomplish close to my ability level. Persons not perfectionistic may be happierbut not accomplish much (p. 397). Of particular import to research and clinical applicati on, the researchers concluded that experts should not assume that they have the same definition of perfectionism as their clients; thus, careful attention is warranted in order to avoid possible assumptions such as believing that perfectionism lacks value for a particular individual. Another implica tion of this conclusion is the continued need for more phenomenological research on perfectionism. To offer a cross-cultural perspective, Slaney, Chadha, Mobley, and Kennedy (2000) interviewed five self-identified Asian Indian perfectionists. Noting striking similarities across cultures, high standards again emerged as a chie f feature of perfectionism. In consonance with Slaney and Ashbys (1996) study, the theme of discrepancy between standards and selfperceived performance emerged in the interviews as evidenced in the following quote: Mother does everything so wellshes never satisfied w ith anything (p. 26). Additionally, the authors noted a clear consensus that participants te nded not to procrastinate and generally saw themselves as efficient, neat, and orderly. Thus, as noted in the other qua litative studies, positive qualities of perfectionism were also highlig hted in the participants responses. Whereas the preceding two qualitative studies (Slaney & Ashby, 1996; Slaney et al., 2000) indeed penetrated more deeply in to the inner experience of self-i dentified or strongly presumed

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33 perfectionists, neither study re lied on a clearly identifiable qua litative methodology in order to systematically interpret the interview material. Conversely, Rice and co lleagues (2003) utilized CQR (Hill et al., 1997) to analyze interviews conducte d with nine participants This line inquiry comprised half of the teams qualitative and quant itative study that sought to arrive at a fuller comprehension of perfectionism from a phenomen ological perspective. Specifically, cluster analysis was used to identify naturally o ccurring groups based on subscales from the Multidimensional Perfectionism Scal e (Frost et al., 1990). Exemplar representatives of adaptive ( n = 2), maladaptive ( n = 4), and non-perfectionist ( n = 3) groups were identified and interviewed by researchers who were b lind to prototype designations. Again, the findings support the multidimensionality of perfectionism. As concluded by the researchers, the meaning of perfection generally includes distress, with the adverb employed deliberately in CQR parlance to hi ghlight that all (or all but one) cases encompassed this attribute. Interestingly, a more exhaustive characterization of distress emerged, one denoting a lack of satisfaction, inefficient and problematic self-regulation, a nd interpersonal difficulties (p. 52). Findings also sugg est that perfectionists typically (i.e., apparent in 5 to 8 of 9 possible cases) desire to perform well. Unfortunately, a lthough this study expands the literature on the phenomenology of perfectionism, that there were too few members in each cluster precluded between-group comparisons of the adaptiv e, maladaptive, and non-perfectionist clusters. Using grounded theory (Glaser and Strauss, 1967), Riley and Shafra n (2005) qualitatively explored the meaning of clinical perfectionism (see Dunkley et al., 2006; Hewitt et al., 2003; Shafran et al., 2002; Shafran et al., 2003) or the overdependence of self-evaluation on the determined pursuit and achievement of personally demanding standards, in at least one domain that is of importance to the individual (p. 369) Results from a mixed sample of clinical ( n = 7)

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34 and non-clinical ( n = 14) participants suggested that self-imposed dysfunctional standards, continual striving, and adverse consequences resu lting from such striving formed the core of clinical perfectionism and also differentiated between perfectionists a nd non-perfectionists. A caveat may be in order: Given that 15 out of 21 participants (71.4 %) se lected from a largely non-clinical sample exhibited the core features of clinical perfectionism, findings should be interpreted with a degree of caution. Nevertheless, Riley and Shafran posit that at least six maintaining mechanisms of clinical perfectionism emerged from the interviews: (a) self-critical reaction to failure, (b) positive emotional reaction to success, (c) cognitive biases, (d) rules and rigidity, (f) avoidance, and (g ) escape. Interestingly, all participants with the core psychopathology of clinical perfectionism exhibi ted cognitive biases, su ch as all-or-nothing thinking, catastrophizing, disqualifying the posit ive, and focusing on the negative (Beck, 1995). This finding parallels that of Rice and colleagues (2003), who point ed out that thinking patterns may be limited in perfectionists. Consistent with other research, Riley an d Shafran conclude that fear of failure and the implications of such failure on self-evaluati on stand out as a chief motivators for striving to achieve : 93.3% of the those identified as clinically perfectionistic demonstrated this motivation as opposed to a mere 16.7% of non-perfectionists. In sum, qualitative studies offer much in te rms of their potential contribution to our understanding of perfectionism. In light of their inductive nature, theory emerges from the data and thereby allows resear chers to penetrate the Erlebnis of the participant. The published literature notably lacks studi es which examine the innermost thoughts and feelings of maladaptive perfectionists. Perhaps illustrative of the general level of distress and impoverished sense of satisfaction already not ed in maladaptive pe rfectionists, the following quote emerged from a participant of the Rice et al. (2003) st udy: Dont call me a perf ectionistIt is like you

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35 wouldnt call an alcoholic a drunk to their [sic] face (p. 51). Appropriate ly, the researchers call attention to the possible treatment implications of such an emotiona lly resonant statement. It is tenable that a more comprehensive understa nding of the inner wo rld of maladaptive perfectionists, a group who does not respond well to typical psychotherapeutic interventions, may later inform psychotherapy and/ or the develo pment of relevant adjunc ts to therapy. Thus, the current study, in addition to connecting the disparat e literatures of expressive writing and perfectionism, seeks to examine the perhaps turbulen t inner world of maladapt ive perfectionists. Present Study To summarize, this review presented the follo wing principal ideas: (a) recent research suggests that perfectionism is indeed a multidim ensional construct with a hybrid adaptive and maladaptive identity; (b) maladaptive pe rfectionism, which encompasses personality characteristics such as harsh self-criticism, a pronounced concern about making mistakes, and a substantial perceived gap between ones perfor mance and expectations, has been repeatedly linked with various psychological difficulties and a lack of amenability to treatment; (c) research supports that the expressive writing paradigm acts as compelling medium to uncover the thoughts and emotions of respondents; (d) CQR is ideally suited to systematically and rigorously identify emergent themes within the writings of maladaptive perfectio nists; and (e) extant qualitative research on perfectionism captures feat ures of the construct wh ich elude quantitative inquiry, and accordingly represents a viable mechanism to expand the perfectionism literature. In what might best be categorized as an in itial step toward uncovering the therapeutic potential of expressive writing for treating perfectionism, the cu rrent study utilizes an emotional writing prompt to penetrate the in ner world of maladaptive perfectionists. More specifically, the present investigation will extend the perfectionism literature by identifying salient themes in the emotion-laden written responses of maladap tive perfectionists. What will maladaptive

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36 perfectionists choose to share when prompted to write about their deepest feelings regarding stress, perfectionism, performance expectations, a nd coping? Which topics will be elaborated on and which will be ignored? In accordance w ith the CQR methodology, a priori hypotheses are not formulated in the current study so that rese archers may remain open to themes that emerge from the data. A more thorough understanding of su ch themes may enrich clinical interventions and inform the creation of subsequent m easures or adjuncts to psychotherapy.

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37 CHAPTER 3 METHOD Participants Fourteen participants were se lected from a larger sample of 264 college students (72 men and 192 women) enrolled in an expressive writin g study. Participants fo r the larger study were recruited from multiple sections of a general psychology course at a public Southeastern U.S. university. Students of general psychology are required to partic ipate in research during the semester or, if they do not wish to be involved in research, they have the option to participate in another activity for the same amount of credit. St udents interested in part icipating signed-on and were scheduled for the initial session thr ough a psychology research pool website containing information about the study. Participation rate s could not be calculated because enrollment figures for all sections of the general psychology course were not determined. At any rate, the substantial time-commitment of th e study (i.e., five visits to the lab for an approximate total of three hours of participation) likely deterred many potential participants. Accordingly, recruitment efforts were sustained for three consecutive semest ers in order to obtain an adequate sample size for the larger project. Ranging in ages from 18 to 27 ( M = 18.56, SD = 1.13), the sample included 67% White/European Americans, 14% Black/African Americans, 10% Latino/as, 4% Asian/Asian Americans, and 5% who identified as multicu ltural/mixed race. Roughly 55% of the students were in their first semester of college and a nother 18% had completed one semester. Overall, approximately 91% of the sample had completed four or fewer semesters. The samples selfreported grade point average, based on a 1.0 to 4.0 scale, was 3.36 (SD = 0.56) and ranged from 1.5 to 4.0.

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38 Inclusion in the current study was limited to those participants who were categorized as maladaptive perfectionists (see below) and completed all three writing sessions in the experimental condition of the larger study. The fi nal sample of 14 participants (5 men and 9 women) ranged in age from 18 to 22 ( M = 18.93, SD = 1.2), and all were White/European Americans. Numerically, near the upper bound of Hill et al.s (2005) target range of 8-15 participants, the 14 cases represent what Hill a nd colleagues have deemed a larger sample (i.e., >12) within the CQR paradigm; samples of th is size tend to produce more stable results, meaning that the inclusion of additional cases would not likely produce significant fluctuations in the findings. Researchers Following Hill et al.s (1997, 2005) recommenda tions for conducting effective CQR, the primary research team consisted of three set me mbers, a number which allows for a variety of perspectives as well as sufficient immersion for each member in all aspects of the data. All three researchers (David J. Hannah, Robert S. Merrell, and Amy C. Van Arsdale) were White/European American graduate students in a counseling psychology doctoral program. Each member served as a judge in the coding tasks. In effect, the utilization of a fixed versus rotating team structure ensures th at each member plays a central role in the tasks of creating domains and core ideas for all the cases. One draw back to this approach is that it may not permit the most effective use of time, given that the formation of domains and core ideas may become repetitive. In light of the richness of pers pective afforded by the fixed primary team, the advantages of such an approach appear to ou tweigh the costs. These benefits are perhaps illustrated by the numerical disparity evident in Hill et al.s (2005) review of a corpus of studies which utilized CQR: 18 studies re lied on set teams as opposed to 9 that employed rotating teams.

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39 Another critical feature of CQR is the role of the auditor, a re searcher who provides detailed feedback at each phase of the analytic process (e.g., construction of domains, formation of core ideas, performing the cross-analysis). C onsistent with Hill et al.s (2005) guidelines, the current study involved two external auditors (i.e., non-primary team researchers), both with prior qualitative research experience a nd one in particular with CQR-sp ecific experience in addition to substantial expertise in the give n realm of inquiry (i.e., perfectio nism research). Regarding the external attribute, adherence to this directive helps ensure the presence of a perspective on the data that is not as influenced by groupthi nk (p. 201), a quality which acquires added significance during the cross-analys is phase. Insofar as the aud itors experience, CQRs authors affirm that prior exposure to this qualitative paradigm in addition to study-specific, contentbased expertise are crucial due to the auditors influence on th e overarching direction of the investigation. Thus, Kenneth G. Rice, a White/European American doctoral-level counseling psychologist with considerable experience in perfec tionism research, served as one auditor. He also fashioned the studys expressive writing prom pt in accordance with other expressive writing research (e.g., Pennebaker & Francis, 1996). Hill et al. emphasize the auditors pivotal role in formation of the interview protoc ol, a procedural analog to the cr eation of the expressive writing paradigm within the current inve stigation. To provide a perspec tive less influenced by extant perfectionism literature, Matthew P. Buman served as the studys second external auditor. A White/European American graduate student spec ializing in sports psychology, Mr. Buman has a range of experience with vari ous qualitative methodologies. Researcher Biases and Expectations As suggested within the CQR paradigm, all th ree primary team members and the auditors acknowledged their biases prior to data analysis by responding to the writing prompt as we

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40 expected participants would respond. Via the di scussion of biases (often referred to as the bracketing of biases; see P onterotto, 2005), researchers gain increased awareness of their implicit assumptions with the intent to minimize their impact on data analysis. For instance, one researcher believed that themes to emerge w ould emphasize personal inadequacy, interpersonal concerns about revealing inadequa cies to others, intense emotiona l reports of significant stress/ distress/ discouragement/ isolati on, and longitudinal persistence of problematic perfectionism. Another researcher suggested that participants would reference familial pressures related to developing and maintaining perfectionism, with perhaps a dominant parent emerging as the driving force behind the participants initial stri ving toward high standards. Another researcher believed that procrastination would be a pe rvasive theme accompanied by the participants fundamental perception of their in ability to change. Remaining assumptions fell into two broad categories: the participants perceived benefits from being perfectionistic (e.g., past and present academic success, greater prospects for graduate school and professional development) and the participants ambivalent views on coping: Whereas some researchers thought the writings would be generally devoid of coping strategies, others believed that participants would reference exercise or other social strategi es in order to help cope with stress related to striving for high standards. In sum, with assumptions spanning a wide gamut, all resear chers were enthused by the line of inquiry. Assumptions explored during this prelimin ary discussion were revisited throughout the data analysis in order to reduce the likeli hood that such biases would unduly influence the research findings. Even though, as Rennie (1997) maintains, it is impossible for investigators totally to become aware of and transcendent ove r the influence of thei r understanding of the phenomena (as cited in Hill et al., 1997, p. 539), it is of paramount importance that researchers

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41 openly acknowledge their biases so as to better e quip themselves to put them aside to the highest degree possible during the analytic pr ocess. Thus, the team frequen tly returned to the content of the initial bracketing of biases discussion in orde r to ensure that coding proceeded as objectively as possible. Measures The Almost Perfect Scale-Revi sed (APS-R; Slaney et al., 1996; Slaney, Rice, Mobley, Trippi, & Ashby, 2001) was used to measure perfectionism (see Appendix A.) A 23-item, selfreport questionnaire, the APS-R in cludes item responses that are based on a 7-point scale (1 = strongly disagree through 7 = strongly agree ). The APS-R yields th e following three subscale scores: the High Standards subsca le (7 items) assesses the degr ee to which respondents endorse high standards and expectations; th e Order subscale (4 items) meas ures preferences for order and organization; and, the Discrepancy subscale (12 items) measures the perceived discrepancy between ones standards and ones self-evaluated ability to reach those standards. Higher scores on the APS-R correspond with greater personal st andards, stronger prefer ences for organization and order, and more self-criti cal evaluations. The APS-R scores have been shown to be adequately reliable, with Cronbachs coefficien t alphas typically in the .85 to .92 range (Slaney et al., 2001) and test-retest reliabili ties (from 3 to as many as 10 we ek intervals) ranging from r = .72 to .87 (Grzegorek et al., 2004; Rice & Ald ea, 2006). Considerab le evidence abounds supporting the convergent, concurrent, and predictiv e validity of the scores with college student samples (Ashby & Rice, 2002; Grzegorek et al ., 2004; Mobley, Slaney, & Rice, 2005; Rice & Aldea, 2006; Slaney et al., 2001; Suddarth & Slaney, 2001).

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42 Procedure Selecting Participants Hill and colleagues (1997) recommend a crit erion-based sampling approach (Goetz & LeCompte, 1984) that sets the criteria for the po pulation prior to data collection. Such an approach allows for greater discernment for when and with whom the results are applicable, thereby providing a meaningful context for the r eader to interpret and understand the results (Hill et al., 1997, p. 530). Given the current studys focus on the emergent themes within the writings of maladaptive perfectionists, the APS-R (Slaney et al., 2001) was utilized to identify those individuals with some depth of experience with the phenomenon unde r study. Participants in the larger sample completed the APS-R within a battery of other m easures at the pretest. Based on the results of the APS-R, participants were cla ssified as adaptive perfectionists, maladaptive perfectionists, or non-perfectionists based on recently developed cutoff criteria (R ice & Ashby, 2007). Consistent with other research and revi ews (e.g., Stoeber & Otto, 2006) the present study used the combination of elevated High Standards scores and elevated Discrepa ncy scores (indicating extreme self-criticism and disappointment with one s performance) to determine inclusion in the maladaptive perfectionist group. Although the meas ure was administered in its entirety, the Order scores were not utilized given that cu rrent research suggests that the APS-R Order subscale or a construct of organization may not be necessary for classification purposes (Ashby, LoCicero, & Kenny, 2003; Martin & Ashby, 2004; Persiamy & Ashby, 2002; Suddarth & Slaney, 2002). Although questionnaire data from the larger study are of intere st for descriptive purposes, the primary focus of this study is on the rich qu alitative data derived from the three writing sessions. To reiterate, inclusion in the curren t study was limited to those participants who were

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43 categorized as maladaptive perfectionists and completed all three writing sessions in the experimental condition of the larger study (see Ap pendix A for control and experimental writing prompts). In the experimental condition, in consonance with other expressive writing research (e.g., Pennebaker & Francis, 1996), participants received a sheet of paper with the following written instructions: Your task is to write about your very deepest thoughts and feelings about stress, perfectionism, performance expectations, and co ping. In your writing, try to let yourself go and to write continuously about your emotions and thought s related to any or a ll of these topics. You can write about a recent event that was stressful or some other pa st experience that you continue to think about these days. You could also focus on classes, your future, your parents or your own expectations. The primary task, however, is for you to reflect on your most basic thoughts and emotions about stress, perfectionism performance expectations, and coping. Respondents addressed the preceding prompt fo r a period of 20 minutes. With a 2-4 day latency period between sessions, ther e were a total of three writing response periods, each based on the same prompt. The same battery of m easures was administered at the posttest, approximately one week after the last writing se ssion. Once the hand-written data were collected, a team of non-primary research ers transcribed the writings verb atim into typed documents. Primary team researchers compared the original hand-written documents with the typed copies to ensure accuracy. Training of the Research Team Hill et al. (2005) highlight the importance of tr aining in order to ensure that researchers possess the requisite knowledge to adeptly follo w the CQR method. Thus, they recommend that trainees study the paradigm as found in Hill a nd colleagues (1997) guide, the groups revisions to the approach (Hill et al., 2005), and severa l exemplar articles (e.g., Knox, Hess, Williams, &

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44 Hill, 2003; Ladany et al., 1997). Training for th e current study involved several weeks of meetings focused on qualitative paradigms in gene ral, with a particular concentration on CQR. The total number of traini ng hours ranged from 15 to 20. Because the researchers and the qualitative process cons titute the primary tools utilized to analyze the data, it is imperative that each researcher feels comfortable assertively voicing his or her opinion while arguing to consensus. Hen ce, the topics of power dynamics and team cohesiveness were emphasized. In the inte rest of creating an atmosphere conducive to intellectual discovery, researchers were urged to raise issues and concerns related to the project and readings as needed. Fina lly, the researchers were alerted to the extensive personal involvement and concomitant stress that may re sult from undertaking qualitative research; given that such research often demands a consider able time commitment devoted to the complex process of sifting through larg e amounts of data and reducing them to meaningful categories (Creswell, 1998), it is conceivabl e that the endeavor may be stre ss-provoking. Consequently, the researchers were urged to suppor t one another throughout the projec t, and they were invited to engage in reflective journaling in order to track how their affec tive reactions may impact their personal well-being in addition to the research project. Data Analysis Hill et al. (1997) clearly delin eate the CQR data analytic procedure in a step-by-step fashion. The following sections briefly summar ize each phase of analys is: identification of domains, abstracting core ideas auditing of domains and core ideas, and cross-analysis. Identification of domains Although Hill et al. (2005) assert that it is acceptable to begin with a start list (Miles & Huberman, 1994) of primary topic areas which em anate from the intervie w questions (analogous to the current studys expressive writing prompt), they add that it is preferable to develop the

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45 domains directly from the data because this met hod better insulates data in terpretation from the researchers preconceived ideas. Hence, th e current study used th e latter approach. To begin, each primary team member indepe ndently (i.e., outside the presence of other team members) read a transcript and segmented th e data into domains, or primary topic areas. Team members then convened and modified (i.e ., added, refined, and eliminated) the domains by discussing and arguing to consensu s. The objective throughout the analysis was to continually gain clarity until the most parsimonious and accurate domains were developed. The next step involved each researcher independently reading through two additional transcripts with the aim of assigning each block of data (i.e., participant statements ranging from a phrase to several sentences reflective of a sim ilar topic) to a domain. The primary team then reconvened to analyze the coding of one of the transcripts in an effort to determine the best possible coding of the data. Again, team me mbers discussed the coding until consensus was achieved and the most accurate depiction of th e data was been captured. Next, each team member coded the data from the third transc ript into the continually evolving domains. Following another team meeting wherein consensus was achieve d, the remaining domain coding was completed by the entire primary team as a un it. Finally, a consensus version including the domains with their corresponding raw material (i .e., excerpts from the writings) was created for each individual transcript. Abstracting core ideas Referred to as boiling down or abstracting (Strauss & Corbin, 1990), this data analytic process involves representing the ra w material with more concision and clarity. Hill et al. (2005) emphasize that this stage relies on editing the part icipants words with the aim of ensuring that the essential quality of the data remains intact; thus, efforts were made to stay as close as possible to the participants pers pectives (i.e., the explicit mean ing of the data) while reducing

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46 redundancies in expression. Each primary team member independently derived core ideas for the same two cases, ideas which were later scru tinized by the entire team and then discussed until consensus was reached. Once a common unde rstanding of the process had been achieved, the remaining cases were divided among the researchers and submitted to the abstraction process. Later, the team examined the core ideas for all cases until arriving at consensus. The final process of seeking a mutually agreed-upon final version allowed fo r all team members to become sufficiently immersed in all aspects of th e data, with team members in effect serving as internal auditors who edit and challenge th e core ideas (Hill et al., p. 200). Auditing of domains and core ideas The primary team created a comprehensive list of the domains from the 14 transcripts and each of the core ideas was categorized within the appropriate domain. This list was submitted to the projects external auditors who, until that po int, had not been involved in any of the prior analytic phases. The auditors sc rutinized the analysis with th e following objectives: to ensure that the participants ideas were categorized a ppropriately, to ascertai n whether the critical material in each domain had been abstracted, and to verify that the phrasing of the core ideas precisely and succinctly reflected the raw data. The auditors provided the prim ary researchers with written feedback. Via a process of referencing the original transc ripts, the primary team examined the auditors comments and determined whether there was sufficient evidence in the transcripts to warrant the proposed modifications. In sum, the auditing process he lped clarify the domains and core ideas. Cross-analysis As a unit, the primary team compared domain s and core ideas across cases to determine a set of categories. Hill and colleagues (1997) refer to the constructi on of categories as a discovery-oriented process (Mahrer, 1988) wherein researchers strive to draw from the raw data

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47 rather than adhering to preconc eived ideas about how categories should be determined. Thus, the process involves the creation of categories based on the cl ustering of domains and core ideas across cases. Category titles were designed to capt ure similarities across cases. Cycling back to the original transcripts for clarification purpos es, the primary team discussed the refining of category titles in order to capture the essenc e of the participants thoughts. The initial development of categories was submitted to the auditors for feedback. Again, the auditors external perspective challenged th e team to think critically about the data, thereby resulting in the modification of categories. Finally, the pr imary team reconvened to discuss and agree on necessary changes. Summary Perfectionism is a complex, multidimensional construct with adaptive and maladaptive features. Maladaptive perfectionism refers to pers onality characteristics such as persistent selfcriticism, chronic and excessive concerns about making mistakes and a significant perceived gap between ones performance and ex pectations. Not surprisingly, maladaptive perfectionism has been associated with psychological maladjustm ent, spanning the gamut from chronic fatigue syndrome to suicidal ideation. Because traditional psychoth erapeutic interventions have typically not been linked with positive treatmen t outcomes, some researchers have concluded that perfectionists may require l onger-term, intensive interventions Thus, alternative modes of psychotherapeutic treatment are sought after, and the expressive wri ting paradigm appears alluring for both practical and theoretical reasons. Emotional writing is al so of immense value in that it offers perfectionists a forum to expre ss their innermost thoughts and feelings, thereby providing rich material for qual itative inquiry. Nevertheless, extant qualitative studies of perfectionism are limited numerically at best and methodologically at worst. Influenced by the keenly descriptive qualitative tr adition, the pres ent study utilizes CQR to identify emergent

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48 themes in the written responses of maladaptive perfectionists, a nd the findings may augment our understanding of perfectionisms insidious e ffects and, consequentl y, bolster clinical interventions.

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49 CHAPTER 4 RESULTS Appendix B includes the number of cases fi tting into the identified domains and categories. Hill et al.s (2005) criteria were used to describe the frequencies of theme occurrence. General refers to themes found in 13 or 14 cases. Typical indicates that 7 to 12 cases included the specified theme, and variant denotes occurrence in 2 to 6 cases. Following a description of the domains in which quotes and core ideas are reported in order to illustrate the results (see Hill et al., 1997, 2005; Ponterotto & Gr ieger, 2007), a brief narrative write-up of the entire typical pattern is presente d as a synthesis of the results ac ross cases. Created from typical themes noted in the cross-analysis, this com posite offers a narrative sense of the average participant while preser ving anonymity. Stress The theme of stress was addressed directly in 13 of the 14 cases. Pa rticipants typically wrote that their stress derived from needing to perform well academically in order to enter or remain in their chosen field of study. For instance, one part icipant reported that the most stressful aspect of her life was concern ove r not getting accepted to medical school and, consequently, her inability to plan more decisive ly for the future. Anot her participant addressed the disappointment and economic implications of falling short academically, two factors which heightened her stress: Thinki ng of how I might disappoint myse lf and my parents and thinking of the risk of loosing [ sic ] my scholarships causes a great deal of stress on me. So much stress in fact that sometimes I think that I could drop out of school right now, not get a degree, and be perfectly happy. I know, however, that I would one day regret it. On a related note, less frequent (variant) themes involved stress relate d to interpersonal rela tionships, ranging from

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50 participants parents to significant others. As il lustrated in the previous excerpt, participants expressed how the possibility of not living up to their parents standards often provoked stress. Coping Participants typically (11 out of 14 cases) addressed the topic of coping in their writings, though preferred strategies varied among the writi ngs. Thus, the variant categories of avoidant coping and coping by (a) social interaction, (b ) physical activity, and (c) drinking alcohol emerged. Avoidant coping refers to the part icipants preference for remaining passive in response to challenges or responsibilities. For in stance, one participant i ndicated that negative feelings toward school often cause her to no t attend classes or study. Another participant expressed that it is difficult for her to monitor her grades due to severe anxiety, so she routinely chooses not to check them. Anot her participant noted that she te nds to wait for situations to become unbearable before she st arts coping, a strategy similar to another pa rticipant who tends to procrastinate with school wor k. Others reported how they are likely to cope through social interaction, citing family, friends, and professional counselors as valuable sources of support. Exercise and sports were also mentioned as helpful coping strategies. Finally, although presented exclusively in a nega tive light, alcohol consumption was also noted as a utilized coping technique. Expectations The domain of expectations surfaced in 11 of 14 transcripts. Personal and parental expectations were most commonly ev ident, largely in the form of expectations for the participant to perform well academically and, in the future professionally. Charac teristic of personal expectations, one participant shared that she ex pects to be perfect academically (obtaining only the As that I expect out of my self), but she finds her expecta tions and motivation are often at odds: I cannot stand not to perf orm well, but I am not interested or motivated enough to care to

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51 put forth the extra effort to get the As. I have to admit, I am really ha rd on myself. Another participant noted her tendency to put enormous pressure on herself to succeed academically, an expectation to perform which has intensified since coming to college. The pressure to succeed beyond the college years also emerged from the wr itings, as evidenced in the following excerpt from another participant: I often worry about my future. Will I be successful after college? I feel if my expectations were not so high I woul d be more comfortable. The theme of parental expectations was also typical, a nd participants shared that thei r parents expect them to do well academically. One participant indicated that my parents put a lot of pressure on me to make good grades like my sister. I know they will be disappointed if I dont, and while they never overwhelm me, I know the pressure is there. Another partic ipant expressed the reciprocal nature of academic achievement and stress, noting that his parents are affected negatively by his grades, which in turn distresses the participan t: My parents expect ations of me was [ sic ] much higher and I also get stressed out th at I am disappointing them. Unmet expectations also emerged as a variant category. One participan t explained that she had a high GPA upon graduating high school, but sh e felt it was never good enough due to her parents high expectations. Another participant expressed that her grades are not as high as she believes they should be, self-report ed evidence that she is not living up to her potential. Other writings captured the perception that college is more challenging than anticipated (e.g., I thought college was going to be diffe rent than this, I knew it woul d be hard but not his hard), which in turn widened the divergence between projected college grades and proven high school performance: As of right now stress is overw helming in my life. My classes are going far worse than I expected they would. I currently ha ve less than passing grades in 3 of my 5 classes which stresses me out on top of the continuous wo rk load that moves to harder material each

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52 weekMy expectations for classe s like general psychology was [ sic ] different, and I thought that the grades I received would refl ect that of my straight As in high school. La stly within the domain of expectations, the tenden cy to be self-critical was also noted. Although a sense of selfcriticism arguably pervaded each of the transcripts, only direct evidence of self-critical writings were retained for this category, as reflected in it s variant frequency. For instance, one participant explained that she has felt incapab le of living up to her expectat ions, and instead has felt fat, tired, and unattractive all the time. Another pa rticipant wrote the following: I have always been a little bit hard on myself Every since I could remember I hated when I wasnt able to achieve something. Social This general domain reflects how frequently th e participants referred to their interactions with other individuals. Allusions to family were found in 12 of the 14 cases, and thus the category of references to family was created in order to emphasize the salience of familial themes within the writings. Even though familial themes are conveyed in other categories (e.g., parental expectations), the near ubiquity of family references across the narratives compelled us to retain the category in its own right. Family app eared to refer directly to parents, though in rare instances siblings were mentioned. As previ ously delineated in the parental expectations domain, family references often assumed the form of ascribing a pressuring influence to parents, chiefly in the realm of their impact on the partic ipants academic strivings. To illustrate, one participant shared that my father dreads bad gr ades and shelling out more money for me to live comfortably. Conversely, parent al influence also emerged in the variant category of social support. One participant explained that parent s are a support system, and another added that friends are also supportive. However, in oppos ition to the uplifting sentiment engendered by social support, the category of interpersonal pr oblems also surfaced in the narratives. For

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53 instance, in a writing excerpt pe ppered with expletives, one participant likened her high school experience to a hell wherein she was surrounded by people who endeavored to make her feel stupid. Another participant re counted an instance where she was offended by an academic advisor with a hurtful and sexi st attitude. After revealing her ongoing struggle with an eating disorder, another participant expl ained that she feels like others are always breathing down her neck and it is hard for her to live without ma king an effort to please them. Lastly, another participant shared her difficulty standing out at college because it is hard to compare to other beautiful, skinny, and funny students. Perfectionism Participants typically addre ssed the topic of perfectionism Writers of 9 out of 14 transcripts either identified themselves as pe rfectionists and/or provi ded their own working definitions of the construct. One writer explained her view on perfectionism as follows: I am very much a perfectionist. Of course, I cannot re ally ever be perfect or do anything perfect, therefore, I get upset and stressed out. Anothe r participant highlighted that she feels like the pressure to be perfect has mounted to an enormous leveland when I dont succeed at something I become somewhat depressed a nd moody. Another participant echoed that sentiment, sharing that I also tend to be a pe rfectionist with everythi ng and often find myself staying up all night to complete assignments, wh ich is really taking a toll on my attitude with people. Beyond merely acknowledg ing their self-proclaimed perf ectionistic nature and its concomitants, some participants provided an unambiguous idea of how they operationalize perfectionism: I am a perfectionist: I would lik e everything I do to be perfect, meaning looking good, sounding good, expressing exact and accurate ideas To do this, I overwork myself trying to fit more and more things into my schedule, expecting my performance to be at the topwell, not merely at the top, but perfect. Another writ er explained that perfectionism is a drive to

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54 please others, which she recognized as being at least partly negative: It makes life challenging but its worth it to please others. Isnt that sick? Its so true though. Variant Domains The following four variant domains also emerged from the analysis: academic/professional goals, affect, adjustment to college living, a nd control. Their constituent categories are identically titled. Apart from the emphasis on academic achievement noted more uniformly throughout the narratives, 6 pa rticipants communicated th e idea of pursuing overarching academic or professional goals, although these goals we re not always explicitly defined. In half of these cases, the focus was sharply on a medi cal career or gaining admission to a different college. The balance of these cases conveyed an allusion to but uncertainty with academic and professional aspirations, made manifest in fr equent changes of major or unconcealed doubts about potential fields of study. Regarding the domain of affect although it was perhaps defensible to identify affect in the overall teno r of any given narrative, we decided to retain only direct statements of participants emotions, such as overt recognition of being depressed, anxious, or unhappy with life. Thus whereas the domain of affect is variant in frequency, this categorization may be partly deceptive given that a strong emotional undercurrent arguably characterized many of the narrativ es. Adjustment to college livi ng included both relational (i.e., missing family and significant other, making friends ) and domestic (i.e., pe rforming activities of daily living such as cooking and wa shing clothes) aspects. Lastl y, the domain of control spanned academic and social areas, as illustrated in one participants words: A recent fight with my girlfriend was very stressful because I felt I was not in control of the situ ation. This lack of control often stresses me out. I feel bad grades gives me the same feeling.

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55 Composite Vignette of a Typical Partic ipant Derived from the Cross-Analysis The participant, Lisa, is a 19 year-ol d, White/European American female who has completed fewer than four college semesters. She acknowledges that sc hool is stress provoking, principally because she tends to strive unceasingl y for academic excellence. College classes are more difficult than she anticipated, yet this awareness doesnt mitigate her feelings of inadequacy when she fails to earn the As she had hoped for and was previously accustomed to receiving. She may attempt to cope with her s ituation, though shes uncl ear whether she prefers to shirk responsibility for a while, head to the gy m, spend time with friends, or maybe have a few drinks. As an added layer of pressure, she feels like her parents also expe ct her to succeed. As she sees it, they are invested both financially and emotionally in her academic success. Because of the pressure to not let herself or her parents down, shes multiply impacted by her lackluster academic performance: Not only are her grades undesirable but she is further stressed by her parents resultant disappointment She describes herself as a pe rfectionist and she knows she can be her own toughest critic, but she continues to overwork despite her admission of pursuing the unattainable goal of perfection.

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56 CHAPTER 5 DISCUSSION This chapter will present a description and analysis of the findings discussed in Chapter 4. First, the findings of the qualita tive analysis will be considered in light of previous research. Emphasis will be placed on the main findings regarding participants stress, personal and parental expectations, conceptua lizations of perfectionism, and referenced coping techniques. Next, implications for practice will be examine d, followed by a review of the studys limitations and directions for future research. Finally, concluding remarks will be offered. Stress, Expectations, Perfectionism, and Coping The main findings of this study involve the part icipants stress relate d to academics, their views on personal and parental expectations, th eir views on perfectionism, and their preferred coping techniques. In most cases, with the excep tion of coping strategies, each of the previously mentioned areas tended to blend together, resultin g in substantial overlap between the domains. That is, stress was often related to either person al and/or parental expectations, which in turn were linked with participants conceptualizati ons of perfectionism. To be sure, no causal relationships could be demonstrat ed in light of the studys design. For uniformity of coding and in an effort to remain faithful to the spirit of CQR, we attempted to remain as close as possible to the participants pers pective (Hill et al., 1997, p. 546) and thus formulated core ideas that mirrored the narratives explicit meanings. Emerge nt patterns were identified during the final cross-analysis. Due to the shared relationships between domains, the distinctions between them may at time appear chiefly academic and it is theref ore advisable to not lose sight of the organic nature of the writings. Consistent with other perfectionism resear ch (Rice et al., 2003; Slaney et al., 2001), distress and standards emerged as two central features of perfectionism. Although we

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57 predominately chose to use the word expectations to convey the idea of high standards, both terms denote the tendency for participants to be markedly demanding of themselves and their performance, contextualized here largely within the realm of academics. Prior qualitative studies demonstrated the centrality of academic achieve ment for perfectionistic individuals. For instance, Slaney and Ashby (1996) found that perf ectionists were motivated to receive praise from others, and Rice and colleagues (2003) concl uded that high grades were often construed as a desirable achievement. This information is pe rhaps not surprising, nor is it surprising that the current analysis revealed stress related to academics in 10 of the 14 cases. Participants typically shared that their need to achieve academically was highly stress-provoking. In fact, one participant shared that her constant pursuit of perfection required her to constantly revise her work, until her mind becomes so overloaded by [her] tasks, wishes, desires, and expectations that she feels like exploding. As if not fazed by her own internal process, she added, I guess that is what happens when you are unde r a highly stressful situation. Closely linked with the idea of academic stre ss were personal expectations. Again, prior quantitative (e.g., Hewitt, Flett, Turnbull-Donovan, & Mi kail, 1991) and qualitative (Rice et al., 2003; Slaney & Ashby, 1996; Slaney et al., 2000) research has demonstrated the association between high personal standards and perfectioni sm, and these findings were supported in the current study. Participants expected to perfor m well academically, and this expectation appeared to emanate at least in part from their own in ternal high standards, though our study was indeed not designed to test causal relationships. As one participant share d, ever since I could remember I hated when I wasnt able to achieve something. My parents never had to put any type of pressure on me to complete my school work b/c [ sic ] they knew I put more than enough pressure on myselfI feel like th e pressure to be perfect has mounted to an enormous levelI

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58 think my major problem is that I take everything a bit too pe rsonally and become way to [ sic ] tensed and stressed out about achieving everything I want. Evident in this participants writing is the pervasive sense of self-criticism that char acterized many of the writi ngs. The astute reader will recall that the category of e xpectations linked with self-criti cism was variant in terms of frequency, although it should be high lighted that rather stringent coding criteria were employed. That is, whereas only directly self-critical remark s (e.g., I feel fat, tire d, and unattractive all the time) were retained for the category, the spirit of being hard on oneself and not living up to ones potential seemed to permeate the writings. Although counterevidence exists in the preceding paragraph, participants expressed their belief that parental expectations constitute a s ource of added pressure to succeed. This finding coincided with Slaney and Ashbys (1996) conclusion that most of their participants viewed one or both of their parents as inst rumental in their perfectionism. Akin to Frost et al.s (1990) conceptualization of a Parental Expectations subscale for perfectionism assessment and Hewitt and Fletts (1991) notion of Soci ally Prescribed perfectionism (i.e., one believes that others externally impose high standards), some participants described how they wished to meet their parents expectations in orde r to not disappoint them. For instance, one participant unambiguously shared that a drive to pleas e others is the defining characteristic of perfectionism. Direct evidence such as this further establishes the ecological validity of socially influenced conceptualizations of perfectionism, and it furt her substantiates previous phenomenological research on perfectionism. Analogously, Rice and colleagues (2003) also noted that the need to live up to others standa rds was a repeated them e in their qualitative analysis.

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59 Half of the participants wrot e about their identity as a perf ectionist. Given the method of participant selection and the cons truction of the writing prompt, this is hardly surprising. Although previous qualitative re search (Slaney & Ashby, 1996; Slan ey et al., 2000) included all or nearly all self-proclaimed pe rfectionists, such unanimity clear ly derives from the respective methodologies (i.e., interviews conducted with self-reported perfectioni sts). Interestingly, participants recognized that thei r perfectionistic strivi ngs caused them distress, yet they did not intimate any willingness to abandon such habits. Despite admittedly overworking and having a perfectionistic nature [that] often causes... problems, none of the participants wrote that they would like to relinquish their pe rfectionistic tendencies, a findi ng which parallels Slaney and Ashbys conclusions. To be sure, the participants were not directly aske d whether or not they would give up these tendencies, though their reticence in this area may carry clinical implications, a point that we return to later. On a related note, that half of the par ticipants did not identify as perfectionists is perhaps equally telling. As a domain, coping themes were noted in 11 out of 14 cases, although a range of disparate strategies was presented. Perhaps most encouragingly, social inte raction was cited as a helpful method of counteracting stress, a finding wh ich at first blush appears inconsistent with prior research that suggested that interpersonal aspects of perfectionistic distress could engender increased feelings of isolation (R ice et al., 2003). Participants explained that getting together with family and friends helped diminish stress. Nevertheless, although so cial interaction as a means of coping did emerge in the current analysis the overall pattern of results was not entirely optimistic. Interpersonal problems also surfaced in several of the transcripts, indicating that whereas coping through social interaction was of valu e to some of the partic ipants, it was also by no means attractive to all participants. For instan ce, one participant shared the following: When

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60 I dont succeed at something I become somewhat depressed and moody. I really dont want to go out. I beat myself up over the mistakes Ive made. Far from a positive coping strategy, this participant expressed her excessive concern for making mistakes a nd how it translates into selfisolating behavior. Participants often remained passive in respons e to challenges or res ponsibilities, tendencies which were reflected the category of avoidant coping. Given that some participants indicated that negative feelings toward school led to not attending clas ses and procrastination, these concerns may bear significant c linical relevance. However, Slaney and Ashbys (1996) question seems appropriate: What degree of procrastination is normal and what constitutes a problem? (p. 396) One participants words may be instruc tive: When I have assignments that are due in the immediate future I may put them off to the la st minute but I never freak out or get too worked up. The question of normal versus pathological mi ght also be raised in reference to the participants acknowledgement of drinking alcoho l in order to cope. When participants referenced drinking alcohol as a means of c oping, frequency of drinki ng episodes and quantity consumed were not specified. It was equally ambiguous whether the participants felt ashamed by the admission or recognized the possible negative repercussions associated with drinking as a coping mechanism. In reading the transcripts, one gets the impression that both interpretations may be tenable. Clinical Implications Counseling-relevant research often responds to the tacit question of wh at clinicians can do differently in their practices based on a studys re sults. In fact, Hill et al. (1997) directly listed this guiding concern as one of the chief criteri a by which to evaluate CQR-based research.

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61 Echoing the suggestions of prior qualitative re searchers of perfectionism (Slaney & Ashby, 1996; Rice et al., 2003), any directio ns proffered herein are not pres criptive and at best tentative. As discussed previously, succe ssfully treating such perfect ionists has proven to be difficult. The paucity of published research on treatment is in part explained by the slim likelihood that that one would present exclusively to confront her or his perfectionism. Halgin and Leahy (1989) wrote that experienced mental h ealth professionals know that college students do not seek treatment for perfectionism (p. 223), a nd results from this and other studies suggest that individuals plainly may not want to address their perfecti onism. Conceivably, a lack of willingness to surrender ones pe rfectionism may derive from its positive concomitants (e.g., praiseworthy achievement in school or work ). Consequently, as Lundh (2004) observed, conceptualizing a clients perfect ionism as a problem to be solved may evoke resistance given that perfectionists often se lectively focus on the benefits of their striving. A clinicians awareness of perfectionisms bittersweet consequences may help guide a more informed and efficacious approach to treatment. In their qualitative study, Slaney and Ashby (1996) concluded that even though partic ipants typically found their perfectionism distressing, not one of those asked said they w ould abandon it. Our results detected a similar unwillingness to relinquish perfectio nistic tendencies, in spite of their deleterious by-products. Recall the participant who explai ned that perfectionism is a d rive to please others which makes life challenging but its worth it to please others. Noting the chal lenge as well as the value in pleasing others (i.e., the self-perceived benefits of subscribing to perfectionism), she then showed insight into the para doxical and self-defeating nature of her stance: Isnt that sick? Its so true though.

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62 The prior participants insistence on the veracity of her statement is perhaps linked with the tendency for participants to normalize their perfectio nistic leanings. To reiterate, one participant divulged that her unceasing pursuit of perfection i nvolves the continual revi sion of work until her mind becomes so overloaded by [her] tasks, wish es, desires, and expectations that she feels like exploding. She proceeded to normalize th is tendency, indicating that her response was natural in the context of a highly stressful situation. Clinicians should remain vigilant, attempting to detect the perfectionistic client s tendency to normalize otherwise destructive thoughts and behaviors. Through dialogue between therapist and client it may be possible to shift the perfectionistic individuals focus away from the identified precipitating event and toward their own inner process/response. Another possible clinical implication involves the use of the expressive writing paradigm with perfectionists. With the exception of one individual, our pa rticipants shared a range of emotionally resonant topics, ranging from painful relationship issues to deaths of loved ones to unrelenting struggles with eating disorders. Fo r instance, one particip ant wrote the following: Its hard when your favorite coping mechanism for a ll of the stress is so harmful to yourself and your relationships w/ [ sic ] other people. I feel trapped. I re ally dont want bulimia anymore, but at the same time its such a part of me that I can hardly stand it. Because this is an isolated case, eating disorders did not numer ically qualify for category status. Nonetheless, this excerpt illustrates the power of the expressive writing pr ompt to elicit deeply emotional responses. Although this study was not designed to determine the efficacy of using the paradigm clinically with perfectionistsand it is conceivable that such writing may have a negative impact because it encourages otherwise perfection-oriented individuals to confront their perceived inadequaciesthe richness of the participants wr itings demonstrated that the paradigm may be

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63 used to penetrate the inner world of perfectionists. In sum, whereas future research is needed to assess the influence of emotion writing, this study convincingl y demonstrated the evocative power of the instrument in our sample of maladaptive perfectionists. Limitations and Directions for Future Research Limitations included herein refe r principally to sample char acteristics and methodological implications. Because Hill et al. (2005) em phasized the importance of addressing bias and testimonial validity in the Disc ussion section, these topics ar e also included. Woven throughout the limitations are directions for future researc h, and additional research ideas are presented in this sections final paragraphs. Before discussing this studys limitations, it is important to highli ght one of its vital strengths, namely the explicit focus on an em pirically categorized sample of maladaptive perfectionists. Prior qualitative research has not devoted direct efforts toward this population that clearly needs a great deal of attention. Given that malada ptive perfectionists are known to be particularly vulnerable to a range of psychological maladies, we believe that our circumscribed sample is not only justified but desi rable. Nevertheless, th e participants may not be a representative sample of maladaptive perfect ionists. The participants were college students with a majority having completed four or fewer semesters. Whereas such a truncated range of individuals fits nicely with Hill et al.s (1997) recommendations that CQR-based studies employ criterion-based sampling so that we can know to whom the results ar e applicable and can provide a meaningful context for the reader to interpret and understand th e results (p. 530), the results are not intended to be generalizable to other groups. Thus, the current findings offer the greatest meaning and interpretabili ty in the context of college development, a fertile ground for this line of inquiry and its s ubsequent application given that as many as 66% of some college

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64 populations can be categorized as perfectionists (Grzegorek et al ., 2004). To be sure, inquiry into non-college samples will enhance future perfectionism research. Also with regard to sample characteristi cs, Hill and colleagues (1997, 2005) recommend that participants should be randomly selected fr om an identified population in order to minimize the intrusion of unknown biases into the study. In the curren t study, inclusion was limited to those participants who were categorized as ma ladaptive perfectionists and completed all three writing sessions in the experimental condition of the larger study. Adherence to these criteria yielded a final sample of 14 participants (5 men and 9 women) who were all White/European Americans. Because the 14 cases represent wh at Hill and colleagues have deemed a larger sample (i.e., >12) within the CQR paradigm, in the interest of rigor we opted to examine each case rather than randomly select from the iden tified population. We based this decision on Hill and colleagues assertion that samples of this si ze tend to produce more stable results within a relatively homogenous population. Again, caution is warranted when attempting to generalize results to the larger societal population, and questions of exte rnal validity might be better conceptualized only within the limited context of college students, and even these claims would be tentative at best. To reiterate, researcher s cannot make claims that their data is [sic] representative of the target popul ation because it is not possible to prove representativeness to the population with this methodology (Hill et al., 1997, p. 559). Naturally, randomly selected participants from larger populat ions of interest will enrich future qualitative research on perfectionism, as will more ethnically diverse samples. Future research conducted with expressive writing and perfectioni sm may particularly benefit from modifying the writing prompt and pa ying closer attention to sample size. Some explanation is necessary. C onsistent with the CQR methodol ogy, a priori hypotheses were not

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65 formulated in order to allow the researchers to remain open to themes which would emerge from the data. Nevertheless, the partic ipants were instructed to respond to a partic ular writing prompt (see Appendix A), which essentially imposed a de gree of constraint on th e possible responses. Accordingly, participants chiefly did conform to the proposed topics of stress, perfectionism, performance expectations, and coping. Whereas the responses were indeed linked in an overarching thematic fashion, it proved difficult to identify smaller pockets of cohesive variation within the domains. As previously mentioned, 14 cases constitute a larger sample size within the CQR methodology. Larger is not necessarily synonymous with sufficient. Fifteen out of the 20 identified categories and free-st anding domains (e.g., affect, adjustment to college living, and control) yielded a variant freque ncy designation (i.e., the category a pplied to 2 to 6 cases). In their CQR methodological update, H ill and colleagues (2005) suggested that a cross-analysis resulting in mostly variant categor ies may in fact reflect that e ither the cross-analysis was not performed with adequate precisi on or that the sample lacked sufficient homogeneity. Either hypothesis is plausible. Another pos sibility is that the prepondera nce of variant ca tegories is an artifact of the open-ended expressive wr iting paradigm. As me ntioned earlier, the tabula rasa that is the emotional disclosure paradigm elic ited a wide expanse of participants responses, which in turn created a rather amorphous mass of thematically-cohesive -yet-loosely-linked data, thereby explaining the number of variant categories. Future res earch in the expressive writing tradition may address this issue through employing a more tightly focused prompt or perhaps an even larger sample size. Not surprisingly, each adjustment carries its attendant assets and liabilities.

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66 Next, the discussion on biases is revisited. In accordance with the CQR paradigm, all three primary team members and the auditors explored th eir biases prior to data analysis by responding to the writing prompt as we expected participants would respond. A full discussion of our bias exploration is included in the Methods chapter. Also in keeping with CQR methodology, researchers are encouraged to provide an hone st assessment of how e xpectations and biases influenced the data analysis (H ill et al., 2005, p.198) in their Di scussion sections. As planned, the assumptions discussed during our primary bracketing talk were continually revisited throughout all phases of the analys is. We noted a tendency early in the analysis process to unwittingly ascribe genders to the participants. Aware that such conjectures would likely skew our perceptions of the data, we e ndeavored to point out when such blind attributions were made. Only after all phases of analysis and auditing we re completed and the Results section had been written did we then identify the participants genders. Another limitation frequently noted in studies pertaining to clini cal aspects of psychology is that of re stricted focus on the pathological. Given that our aim was to deepen our unders tanding of an often debilitating side of perfectionism, we may have had greater sensitiv ity in detecting perfec tionisms less attractive aspects, though it is noteworthy that much effort was devoted to remaining as close as possible to the participants exp licit meaning, as best as we could percei ve it through the consensual process. Overall, bias is an unavoidable factor with in any realm of inquiry. We attempted to mitigate its effects with an open recognition of it s nature and an analytical process involving three researchers repeatedly arguing to consensus. In turn, the primary team was kept in check by two external auditors. Nonetheless, some uni queness of our results clearly derives from how the group functioned collectively and to deny such would be nave.

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67 In an effort to enhance the trustworthiness of the data, Stiles (1993) endorsed the idea of having the data analyses reviewed by the participants. Referri ng to the testimonial validity of this practice, Stiles maintained that this step of data checking enhanced qualitative research, in effect providing both researchers and the scientific community with greater confidence in the adequacy of the findings. Nonetheless, Hill et al (1997) initially argued th at researchers are not obliged to engage in such member checking (L incoln & Guba, 1985) practices, in part due to logistical and phenomenological reas ons (i.e., the overall results wi ll not likely conform to the specific experience of a single individual). They did, however, recommend that researchers note the lack of testimonial validity as a limitation. Gi ven that Hill et al. ( 2005) continued to question the utility of member checking ba sed on a critical review of the efficacy of the practice within published research, the limitation here noted should be viewed within its proper context. Future studies incorporating expressive writ ing and CQR analysis may be expedited via the use of a start list (Miles & Huberman, 1994) of primary topic areas derived directly from the studys expressive writing prompt. We fo llowed Hill and colleagues (2005) directive and opted not to do this. Instead, within the domain identification phase of inquiry, each primary team member independently (i.e., outside the presence of other team members) read a transcript and segmented the data into domains, or primar y topic areas. Once the process was generally understood, we then coded material into domains as a group. The process was highly iterative and involved frequent re-analysis of the cases as our understanding deepened. Our decision to subscribe to this process was based on Hill et al.s assertion that it is advantageous to extract the domains directly from the data because this met hod better insulates data in terpretation from the researchers preconceived ideas. Nonethele ss, Hill and colleagues admit it is acceptable though not preferableto begin with a start list. In our expe rience, a start list would have

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68 been equally effective and more time efficient. Similar studies may consider this input, though we can not dismiss the idiosyncratic nature of this or any study. Future qualitative research on perfectionism may benefit fr om employing more constrained writing prompts and/or interviews The emergent categories fr om the current study (e.g., stress related to academics, personal and parental expe ctations) could individual ly serve as interview topics or exclusive writing themes. Undoubtedl y, a sharper research fo cus would facilitate a deeper exploration of the themes identified in this study, and the resultant data would likely be more conducive to the extraction of more detaile d, information-rich categories. Additionally, a juxtaposition of adaptive and maladaptive pe rfectionists would also be informative and potentially hold considerable c linical significance. Namely, each type of perfectionist could respond to a given topic, such as stress relate d to academics. Data could be analyzed and examined for both convergent and divergent elemen ts. Possible findings could help shed light on how these individuals conceptualize their stress and academics. Other implications may extend to psychoeducational techniques aimed at helping maladaptive perfectionists move closer toward harnessing their pe rfectionism adaptively. Concluding Remarks This study sought to penetrate the inner wo rld of maladaptive perfectionists via a qualitative analysis of their responses to an emotional writing prompt. Specifically, we wondered what maladaptive perfectionists would c hoose to share when asked to write about their deepest feelings regarding stress, perfectionism, performance expectations, and coping. Perhaps a more primary question would have been whether or not the participants would choose to reveal anything of personal relevance given the somewh at impersonal nature of the study (i.e., coming to a psychology lab in exchange for course credit s). That is, at first blush it would seem more likely that participants were seeking to fulfill a course requirement rather than to expose their

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69 innermost feelings to an unknown a udience. Nevertheless, participan ts did in fact opt to share a wealth of emotionally charged material, thereby lending credence to Pennebakers (1997) claim: the writing session is exceptionally powerful [because] participants disclose a remarkable range and depth of traumatic experiences . If nothing else, the paradi gm demonstrates that when individuals are given the opportunity to disclo se deeply personal aspect s of their lives, they readily do so (p. 162). In fact, only one participant chose to write from a detached perspective, opting to use only one first person pronoun in her narrative. Perhaps best characterized as distanced or theoretical, her written response starkly contrast ed to the at times highly personal responses of the other participants. Shar ing personal material involving amorous and psychological difficulties, the participants candor and transparency may i ndicate the potency of the expressive writing paradigm for eliciting maladaptive perfectionists to share their inner struggles. Results of this study support previous perfectionism resear ch in that distress and high standards emerged as core themes from the particip ants writings. Hardly surprisingly in light of sample characteristics, academic pressure was often associated with participants stress. Parental expectations also played a pivotal role in the participants experience. Whereas future studies can extend the psychological literature and our understanding of perfectionism via the employment of more directed writing prompts, the current study represents an important preliminary step in exploring th e inner world of maladaptive perf ectionists, as evidenced in one participants remarks: I am a perfectionist: I would like everything I do to be perfect, meaning looking good, sounding good, expressing exact and accu rate ideas. To do this, I overwork myself trying to fit more and more things into my schedule but expecting my performance to be at the top well, not merely at the top but perfect. Deep down I know that perfection cant be

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70 reached and that I will always fi nd something that I do not like about my performance. I keep on aiming for perfection.

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71 APPENDIX A MEASURES APS-R: The following items are designed to measure certain attitudes people have toward themselves, their performance, and toward others. It is important that your answers be true and accurate for you. In the space next to the statement, please enter a number from "1" (strongly disagree) to "7" (strongly agree) to describe your degree of agreement with each item. STRONGLY DISAGREE 1 DISAGREE 2 SLIGHTLY DISAGREE 3 NEUTRAL 4 SLIGHTLY AGREE 5 AGREE 6 STRONGLY AGREE 7 _____ 1. I have high standards for my performance at work or at school. _____ 2. I am an orderly person. _____ 3. I often feel frustrated because I cant meet my goals. _____ 4. Neatness is important to me. _____ 5. If you dont expect much out of yourself you will never succeed. _____ 6. My best just never seems to be good enough for me. _____ 7. I think things should be put away in their place. _____ 8. I have high expectations for myself. _____ 9. I rarely live up to my high standards. _____ 10. I like to always be organized and disciplined. _____ 11. Doing my best never seems to be enough. _____ 12. I set very high standards for myself. _____ 13. I am never satisfied with my accomplishments. _____ 14. I expect the best from myself. _____ 15. I often worry about not measuring up to my own expectations. _____ 16. My performance rarely measures up to my standards. _____ 17. I am not satisfied even when I know I have done my best. _____ 18. I am seldom able to meet my own high standards for performance. _____ 19. I try to do my best at everything I do. _____ 20. I am hardly ever satisfied with my performance. _____ 21. I hardly ever feel that what Ive done is good enough. _____ 22. I have a strong need to strive for excellence. _____ 23. I often feel disappointment after completing a task because I know I could have done better. _____ 24. Using the scale above, please rate t he degree to which you agree that you are perfectionistic.

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72 Writing Prompt: Experimental condition: Your task is to write about your very deepest thoughts and feelings about stress, perfectionism performance expectations, and coping. In your writing, try to let yourself go and to write continuously about your emotions and thoughts related to any or all of these topics. You can write abou t a recent event that was stressful or some other past experience that you continue to think about these days. Y ou could also focus on classes, your future, your parents or your own expectatio ns. The primary task, however, is for you to reflect on your most basic thoughts and emoti ons about stress, perfectionism, performance expectations, and coping. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

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73 Writing Prompt: Experimental Condition: Your task is to describe in writing any particular object or event of your choosing. In your writing, try to descri be some object or event as objectively as you can, without mentioni ng your emotions, opinions, or beliefs. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

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74 APPENDIX B CATEGORY FREQUENCIES Table B-1. Summary of domain s and categories from the anal ysis of 14 expressive writing transcripts Domain Category Frequency Stress General Stress related to academics Typical Stress related to interpersonal relationships Variant Coping Typical Avoidant coping Variant Coping by social interaction Variant Coping by physical activity Variant Coping by drinking alcohol Variant Expectations Typical Personal expectations Typical Parental expectations Typical Unmet expectations Variant Expectations linked with selfcriticism Variant Social General References to family Typical Social support Variant Interpersonal problems Variant Perfectionism Typical Identifying as a perfectionist Typical Definition of perfectionism Variant Academic/professional goals Variant Committed to goals Variant Uncertain goals Variant Affect Variant Adjustment to college living Variant Control Variant Note. General = applies to 13 or 14 ca ses; typical = applies to 7 to 12 cases; variant = applies to 2 to 6 cases. Domains or categories repres ented in only one case are not included.

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75 LIST OF REFERENCES Ashby, J., & Kottman, T. (1996). Inferiority as a distinction between normal and neurotic perfectionism. Individual Psychology 52, 237-245. Ashby, J. S., Kottman, T., & Stoltz, K. (2006). Multidimensional perfectionism and personality priorities. Journal of Individual Psychology, 62, 312-323. Ashby, J. S., & Rice, K. G. (2002). Perfectionism dysfunctional attitude s, and self-esteem: A structural equations analysis. Journal of Counseling and Development, 80 197-203. Ashby, J. S., Rice, K. G., & Martin, J. (2006). Perfectionism, shame, and depression. Journal of Counseling and Development, 84, 148-157. Batten, S.V., Follette, V.M., Rasmussen Hall, M.L., & Palm, K. M. (2002). Physical and psychological effects of written disclo sure among sexual abuse survivors. Behavior Therapy, 33, 107-122. Beevers, C. G., & Miller, I. W. (2004). Pe rfectionism, cognitive bias, and hopelessness as prospective predictors of suicidal ideation. Suicide and Life-Threate ning Behavior, 34, 126-137. Blatt, S. J. (1992). The differential effect of psychotherapy and psychoa nalysis on anaclitic and introjective patients: The Menninger Psyc hotherapy Research Project revisited. Journal of the American Psychoanalytic Association, 40 691-724. Blatt, S. J. (1995). The dest ructiveness of perfectionism. American Psychologist, 50, 1003-1020. Blatt, S. J., Quinlan, D. M., Pilkonis, P. A., & Shea. M. T. (1995). Impact of perfectionism and need for approval on the brief treatment of de pression: The National Institute of Mental Health Treatment of Depression Collabor ative Research Program revisited. Journal of Consulting and Clinical Psychology, 63, 125-132. Blatt, S. J., & Zuroff, D. C. ( 2002). Perfectionism in the therapeuti c process. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 393-406). Washington, DC: American Psychological Association. Blatt, S. J., Zuroff, D. C., Bondi, C. M., Sani slow, C. A., III, & Pilkonis, P. (1998). When and how perfectionism impedes the brief treatmen t of depression: Further analyses of the National Institute of Mental Health Treatme nt of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 66, 423-428. Bolton, G., Hewlett, S., Lago, C., & Wright, J. K. (2004). Writing cures: An introductory handbook of writing in counseling and therapy. New York: Brunner/Routledge, Hove. Burns, D. (1980). The perfectioni sts script for self-defeat. Psychology Today, November, 34-52.

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76 Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions Thousand Oaks, CA: Sage. de Moore, C., Sterner, J., Hall, M., Warneke, C., Gilani, Z., Amato, R., et al. (2002). A pilot study of the effects of expressive writing on psychological and behavi oral adjustment in patients enrolled in a Phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychology, 21, 615-619. Denzin, N. K., & Lincoln, Y. S. (Eds.). (2000). Handbook of qualitative research (2nd ed.). Thousand Oaks, CA: Sage. DiBartolo, P. M., Frost, R. O ., Dixon, A., & Almodovar, S. (2001) Can cognitive restructuring reduce the disruption associated with perfectionistic concerns? Behavior Therapy, 32, 167-184. Dickinson, W.L., & Ashby, J.S. (2005). Multidimen sional perfectionism and ego defenses. Journal of College Student Psychotherapy, 19, 41-54. Donnelly, D. A., & Murray, E. J. (1991). Cognitive and emotional changes in written essays and therapy interviews. Journal of Social and Clinical Psychology, 10 334. Dunkley, D.M., Sanislow, C.A., Grilo, C. M., & McGlashan, T. H. (2006). Perfectionism and depressive symptoms 3 years later: Negative social intera ctions, avoidant coping, and perceived social s upport as mediators. Comprehensive Psychiatry, 47, 106-115. Ellis, A. E. (1962). Reason and emotion in psychotherapy Secaucus, NJ: The Citadel Press. Fairburn, C. G., Cooper, Z., Doll, H. A., & We lch, S. L. (1999). Risk factors for anorexia nervosa: three integrated case-control comparisons. Archives of General Psychiatry, 56 468-76. Farber, S. K. (2005). Free association recons idered: The talking cure the writing cure. Journal of the American Academy of Psychoa nalysis and Dynamic Psychiatry, 33 249-273. Fawzy, F.I., Fawzy, N.W., Hyun, C. S., Elashoff, R., Guthrie, D., Fahey, J.L., & Morton, D.L. (1993). Malignant melanoma: Effects of an early structured psychiatric intervention, coping, and affective state on recurr ence and survival 6 years later. Archives of General Psychiatry, 50, 680-689. Ferguson, K. L. & Rodway, G. R. (1994). Cogniti ve behavioral treatme nt of perfectionism: initial evaluation studies. Research and Social Work Practice, 4, 283-308. Flett, G. L., & Hewitt, P. L. (2002a). Perfectionism: Theory, re search, and treatment. Washington, DC: American Psychological Association.

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84 BIOGRAPHICAL SKETCH Born and raised in Oak Ridge, New Je rsey, Robert S. Merrell graduated summa cum laude from Villanova University. He was elected to Phi Beta Kappa and received the universitys prestigious medallion for academic excellence in modern languages. Expanding on his international study experiences in Europe and So uth America, he also completed an MA in Spanish Literature and later went on to teach at Villanova and Bryn Mawr College. Currently, he holds a fellowship at the University of Flor ida where hes pursuing a doctoral degree in psychology. His interests include guitar playing, running, and beach combing.