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How to Treat the ‘Perfect’ Client: OCD, Perfectionism, and Narcissism

How to Treat the ‘Perfect’ Client: OCD, Perfectionism, and Narcissism

What happens when a client’s relentless pursuit of perfection not only disrupts their well-being but also hinders therapeutic progress? Clients presenting with Obsessive-Compulsive Disorder (OCD), perfectionism, and narcissism often challenge therapists with interwoven patterns of rigid thinking, compulsive behaviours, and a deeply ingrained fear of vulnerability. These clients are not just dealing with symptoms—they are navigating psychological structures that resist change, leaving both themselves and their therapists feeling stuck.

Times:
6:00 pm – 9:00 pm, London UK

1:00 pm – 4:00 pm, New York, USA

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Original price was: £ 72.00.Current price is: £ 62.00.

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Course Credits

CPD: 3 / CE: 3

Speaker(s)

Dr Jan McGregor Hepburn, Dr Chrissy Jayarajah

Course length in hours

3 hrs of video content

Location

Online streaming only

Full course information

Understanding why OCD, perfectionism, and narcissism often coexist is essential for effectively treating these clients. At the core of these issues is a profound need for control. Clients with OCD may engage in repetitive rituals to manage overwhelming anxiety, while perfectionism drives them toward unattainable standards as a way to escape perceived flaws. Narcissistic traits further complicate the dynamic, as the client’s self-worth becomes entangled with the illusion of perfection, masking deeper vulnerabilities. Together, these conditions form a rigid defence system, trapping clients in cycles of shame, obsession, and emotional isolation.

Building Practical Skills for Intervention

This training will help you distinguish between OCD, perfectionism, and OCPD, and explore how narcissism entangles with and further complicates these presentations. You will also gain practical skills for intervening in ways that facilitate meaningful change. To understand these manifestations in clinical settings, we will explore case examples that illustrate the complex interplay of these conditions and offer insights into effective therapeutic interventions:

Case Example 1: The Perfectionist in Disguise

Jane (not her real name), a high-achieving lawyer, sought therapy for “work stress.” Her need to be flawless at work had led to long hours and growing anxiety over the smallest mistakes. However, her obsession with control extended beyond her professional life—she maintained rigid routines at home, meticulously organising her environment to avoid feeling overwhelmed. Her underlying perfectionism, fuelled by narcissistic fears of inadequacy, had merged with obsessive behaviours, creating a cycle she felt powerless to break. This case will illustrate how perfectionism and OCD can overlap and how exploring the deeper fears that drive these behaviours opens a pathway to change.

Case Example 2: The Narcissistic Shield

Tom (not his real name), a successful entrepreneur, exhibited obsessive behaviours around cleanliness and order. His partner described him as emotionally distant, critical, and controlling—hallmarks of his rigid perfectionism. Tom’s compulsions masked his deeper fear of vulnerability, with his narcissistic defences preventing him from admitting any personal shortcomings. His constant need to maintain a flawless image, combined with OCD-like rituals, created tension in his relationships, as others found him impossible to please. This case will help participants understand the interaction between narcissism, perfectionism, and OCD, and how to intervene when these dynamics obstruct emotional growth and relational intimacy.

Key Questions Explored:

  • How can therapists differentiate between OCD and perfectionism?

We will explore the diagnostic distinctions between these conditions. OCD is characterised by compulsive behaviours intended to manage anxiety, whereas perfectionism often manifests as a drive for unattainable standards, with or without overt rituals. We will also delve into Obsessive-Compulsive Personality Disorder (OCPD), where perfectionism becomes a pervasive way of life, often impairing clients’ relationships and daily functioning.

  • Where do OCD, perfectionism, and narcissism intersect?

This training will focus on the interplay of these conditions. Clients may use obsessive-compulsive behaviours to alleviate anxiety about perceived imperfections, while narcissism drives them to maintain an image of flawlessness. We’ll explore how these defences not only reinforce one another but also hinder therapeutic progress, offering strategies to break these cycles.

  • How can clinicians approach therapeutic intervention in complex cases?

Grounded in both psychodynamic and neuroscientific research, this training will provide strategies for intervening in cases where OCD, perfectionism, and narcissism co-occur. Participants will learn how to work through these defences and guide clients toward healthier, more flexible ways of relating to themselves and others.

The Clinical Imperative:

As psychotherapists or psychologists, we’ve likely encountered clients who display these patterns in subtle and not-so-subtle ways. Perhaps you’ve worked with a client who is paralysed by indecision because they believe anything less than perfect will be a personal failure. Maybe you’ve seen how a client’s need for control manifests as extreme rigidity in their relationships—micromanaging loved ones to the point of alienation. These behaviours, common to perfectionism, OCD, and narcissism, create significant therapeutic challenges.

In practice, perfectionism often remains hidden beneath obsessive behaviours, and when left unchecked, it can evolve into more pervasive personality structures like Obsessive-Compulsive Personality Disorder (OCPD). Clients with OCPD typically exhibit a preoccupation with order, rules, and control, often at the expense of flexibility and spontaneity in their relationships. These clients can be challenging to engage in therapy because their defences seem to serve them well—until they don’t.

Skills and Insights Gained by Attending:

  • Diagnostic Precision: Gain a clearer understanding of the differences between OCD, perfectionism, and OCPD, and learn how to identify these traits in clients. You will also explore the co-occurring conditions that often accompany these presentations, such as anxiety disorders or autistic spectrum traits, and how these impact treatment.
  • Theoretical and Practical Insights: Gain an in-depth understanding of the current neuroscientific and psychodynamic theories that explain the roots of OCD, perfectionism, and narcissism. This training will delve into key findings, such as the role of the cortico-striato-thalamo-cortical (CSTC) circuit in driving compulsive behaviours in OCD, alongside psychodynamic theories of unconscious defences. These insights will help therapists understand the mechanisms that maintain these conditions and inform therapeutic approaches.
  • Case-Based Learning: With case examples drawn from clinical practice, you will explore how to apply theoretical knowledge to real-world therapy. Learn how to identify the underlying psychological drivers behind compulsive and perfectionist behaviours, and how to intervene effectively.
  • Therapeutic Tools: Develop practical strategies for breaking through the rigid defences that maintain perfectionism, obsessive-compulsive behaviours, and narcissism. Learn how to create a therapeutic space where clients feel safe enough to explore their vulnerabilities and begin to challenge their rigid patterns.
  • Empowering Change: Equip clients with the tools to embrace imperfection and flexibility, guiding them toward a more authentic, compassionate relationship with themselves and others.

If you’ve ever worked with a client who seemed trapped in the pursuit of perfection, or whose obsessive behaviours masked deeper emotional struggles, this seminar will provide you with the insights and tools you need. Sign up today to enhance your clinical practice and learn how to address these complex and often misunderstood disorders. Spaces are limited, so secure your spot now to ensure you don’t miss out on this vital learning opportunity.

Learning Objectives:

  • Explain the differences between OCD, perfectionism, and OCPD, and how to identify these traits in clients.
  • Discuss the neuroscientific and psychodynamic theories that explain the roots of OCD, perfectionism, and narcissism including key findings, such as the role of the cortico-striato-thalamo-cortical (CSTC) circuit in driving compulsive behaviours in OCD.
  • Apply practical strategies for breaking through the rigid defences that maintain perfectionism, obsessive-compulsive behaviours, and narcissism.

© nscience 2024 / 25

What's included in this course

What you’ll learn

This training will help you distinguish between OCD, perfectionism, and OCPD, and explore how narcissism entangles with and further complicates these presentations. You will also gain practical skills for intervening in ways that facilitate meaningful change.

Learning objectives

  • Explain the differences between OCD, perfectionism, and OCPD, and how to identify these traits in clients.
  • Discuss the neuroscientific and psychodynamic theories that explain the roots of OCD, perfectionism, and narcissism including key findings, such as the role of the cortico-striato-thalamo-cortical (CSTC) circuit in driving compulsive behaviours in OCD.
  • Apply practical strategies for breaking through the rigid defences that maintain perfectionism, obsessive-compulsive behaviours, and narcissism.

You'll also be able to...

Develop the ability to interpret and modulate the body’s nervous system (sensory and autonomic) to regulate arousal levels in clients and for safer trauma therapy

Identify and acquire recovery options and strategies for trauma clients inappropriate for trauma memory processing, particularly for those who don’t want to and those who decompensate or dysregulate from memory work

Also develop the ability to interpret and modulate the body’s nervous system (sensory and autonomic) to regulate arousal levels for professional self-care

About the speaker(s)

Dr Jan McGregor Hepburn has a background in Social Work Management and Psychoanalytic Psychotherapy and is a trainer for the North of England Association for Training in Psychoanalytic Psychotherapy. She was the Registrar of the British Psychoanalytic Council for 15 years and currently chairs the Professional Standards Committee. She is the author of several papers, most notably those published in the British Journal of Psychotherapy and European Psychotherapy Journal. She has presented papers at conferences and devised and facilitated both seminars and workshops on a variety of subjects to both management dynamics and clinical topics.

She is part of the ScopEd project which is the collaboration between BACP, UKCP and BPC to map the core competencies for clinical work. She is on the Reading Panel of the British Journal of Psychotherapy and has a doctorate from the University of Northumbria. Her latest book: Guilt and Shame, A Clinician’s Guide is out now with nscience publishing house.

Jan was awarded the BPC Lifetime Achievement Award in November 2023 in recognition of her great contributions to the profession and the BPC.

Dr Chrissy Jayarajah MBBS MRCPsych DFSRH is Clinical Lead for CNWL Perinatal Services. She trained at Brighton and Sussex Medical School and completed her psychiatry training in London, with additional training in systemic (family) psychotherapy and forensic psychiatry. As a member of the Royal College of Obstetrics and Gynaecologists with a Diploma in reproductive and sexual health, Dr Jayarajah has a keen interest in women’s health. She has developed Maternity Unit guidance for the management of mental health during pregnancy and delivery and has expertise in providing training surrounding identification of vulnerable women; including issues surrounding sexual health, domestic violence, forced marriage, female genital mutilation (FGM) and women in prison. She is scientific adviser for the Maternal OCD Charity and has expertise in the management and treatment of perinatal OCD and use of medication during pregnancy and breastfeeding.

3 reasons why you should attend this course

nscience UK is approved by the American Psychological Association to sponsor continuing education for psychologists. nscience UK maintains responsibility for this program and its content.

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