Deconstructing

perfectionism:
Narrative conversations with
those suffering from eating issues
by Shona Russell

Shona Russell works as a counsellor at Dulwich Centre,

Adelaide, South Australia. Alongside her counselling work,
for the past few years Shona has been a key member of
the Dulwich Centre Teaching Faculty which has involved
offering workshops in Australia and overseas. She can be
contacted c/o Dulwich Centre, Hutt St PO Box 7192,
Adelaide, 5000, South Australia. Or via email:
shonarussell@internode.on.net

In this paper, I will discuss some of the narrative practices that have
guided me in work with people suffering the effects of eating disorders.
In preparing this paper, I have chosen to carefully review notes and
transcripts of therapeutic conversations that span several years and which
trace the journey of Katerina in her determination to reclaim her life from
illness. I would like to acknowledge and thank Katerina for her significant
contribution to our work together and for her willingness to share aspects
of her life.

Keywords: eating issues, perfectionism, narrative practice, double-listening

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INTRODUCING KATERINA
When I first met Katerina, she was thirty-five,
and had been very ill for some time with what she
described as a form of chronic fatigue syndrome.
Digestive issues had been a big part of her illness,
with her weight hovering under six stone, or thirty-
eight kilograms, for many years. She had been living
a very home-based life for nearly five years, most of
it in the home-support of her mother. She described
her understanding of her illness, particularly its
early stages, as ‘an almost complete collapse’ and
‘a sustained sense of physical, mental-emotional,
and spiritual crisis’. Katerina had taken this very
seriously as ‘a call to connect with her own passions
and life-commitments’.
Katerina came to see me because she felt she
was at a turning point in her illness. She said she
could tell that her base physical resilience was
returning as there had been a reduction in her
levels of pain. The main issue now was what she
called the ‘habits of illness’ by which she felt
trapped. The most significant of these, she felt,
were complex issues around food and self-care
which she had come to believe constituted an
eating disorder. ‘It’s kind of a side-ways eating
disorder’, she said. ‘It’s not anorexia, it’s not
bulimia, but it is preventing me from moving to find
out what wellness might mean for me.’
As well as addressing the specifics of her food
issues, Katerina was interested in identifying her
own way of threading together the different strands
of her experience during her illness. She had been
engaged in a conscious attempt at healing for a very
long time, utilising a whole range of approaches and
modalities. There had been some very influential
ideas and personalities during this time, and the
process had become very stressful for her. She was
feeling overwhelmed and torn by a sense of conflict
about what she had been trying to balance and
commit to. She had been working very, very hard
and was exhausted.
Towards the end of our first meeting when
Katerina was describing all this, she asked me what
kind of approach I might take in working with her –
if indeed I was interested in working with her. I told
her that I would be very interested, and that I was
struck by how much work she had already done. Our
conversations would not be about me offering her
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advice, I said, but I did have an idea for a way into
our explorations together, which it didn’t sound as if
she had tried before. My suggestion was that we
start by me asking her some questions about her
life and she agreed that at our next meeting we
would start out on our investigations.
Some weeks elapsed before our second meeting
and, by this time, Katerina was in severe psycho-
physical crisis. Her weight had dropped to five stone
(or thirty-two kilograms), and she was completely
overwhelmed by the most basic of daily decisions,
particularly those relating to food. Our next
conversation, and those for some months
afterwards, took place at her bedside. Katerina was
in a constant state of internal terror. She was
experiencing a profound sense of moral failure in
relation to her life. She ‘wasn’t being the kind of
person’ that she thought she should be. She
‘couldn’t be the kind of person’ she thought she
should be. Katerina described that ‘she didn’t know
how to make a life anymore’. She spoke about not
knowing how to proceed.
In these first meetings, when Katerina’s sense
of identity was shaped by this profound sense of
moral failure, my inquiries were informed by the
narrative practice of externalising conversations. An
important phrase emerged in our conversations and
was externalised as the ‘habits of illness’. Gradually,
we started to identify particular habits of illness and
the ways in which they worked. We used Katerina’s
words and started to shed light on the activities of
some of these ‘habits’. Over time, Katerina started
to put broader experiences into language. Through a
process of paying attention to Katerina’s precise
words, externalised names were found for a range of
forces, struggles, and habits that hindered her:
FORCES, STRUGGLES, HABITS
• the habits of illness
• unrelenting thought – ‘the thought grip’
• constant responsibility
• fears
• perfectionism
• the perfectionism trap
• the prism of perfectionism
• the monitoring monster
• eating habits
 • binge
• habits of unloving eating
• obe – obliterating eating.
BROAD EXTERNALISING CONVERSATIONS
Identifying perfectionism was one of the most
influential parts of our conversations together and
I would now like to focus on this aspect of our work.
Through externalising conversations, perfectionism
was characterised as a force, a very powerful force
that was strongly shaping and influencing Katerina’s
life. Up until then, perfectionism had never been
named and we soon learned that this had enabled it
to rampage through virtually all areas of her life.
Perfectionism played a key role in driving Katerina
to try to live life according to certain moral
standards that she could not obtain. The standards
were so high and so impossible to achieve that it
was exhausting her. While it was probably invisible
to other people, her life had been taken over by
impossible-to-achieve expectations.
Over time, Katerina identified many different
ways in which perfectionism worked and operated in
her life. There may have been up to twenty different
practices that she identified, often in poetic ways.
From the beginning of our work, the written word
became an important form of acknowledgement for
understandings and knowledges Katerina had about
her life. One document that we wrote together
declared that: ‘The ultimate strategy of
perfectionism is to freeze me from any movement
whatsoever …’
As perfectionism was externalised, Katerina was
able to describe how it encouraged her to feel she
no longer had any ideas about her own life, and that
what was ruling or guiding her life were the ideas of
others. Identifying the practices of perfectionism as
a form of judgement that monitored and completely
controlled her ideas about how life should be,
became central in our work together.
LOCATING PERFECTIONISM IN A BROADER
SOCIAL AND RELATIONAL CONTEXT
Once perfectionism was named, we could begin
to explore the circumstances or conditions which
could contribute to its existence. In conversations
with Katerina, I would ask questions such as ‘What
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circumstances of life, or what conditions of life,
would contribute to the development of
“perfectionism”?’ In response to such enquiries,
she began to identify that there were certain
gendered assumptions within her local culture that
may have contributed to the idea that she as a
woman could be expected to ‘fix things’ and to
create perfect conditions around her for others.
Part of the way perfectionism worked was gendered
in the sense that it thrived upon the view that she
(and other women) had to make things right for
others, and that there could be no rest until that
was achieved. Katerina started to identify this as an
enormous goal, and to question whether it was even
possible to achieve.
We also began to tentatively explore whether
there were contributing factors or events in
Katerina’s own history that may have contributed to
the development of perfectionism. I asked questions
such as, ‘Can you think of any things that might
have been going on at other times in life that may
have contributed to the rise of perfectionism?’
Over time, we were able to trace a history of the
development of perfectionism in Katerina’s life.
A series of events were linked across time that had
contributed to this sense of judgement that had
become associated with a sense of moral failure.
In a review of our work, I interviewed Katerina
about what she found helpful, and I would like to
share part of this conversation now.
KATERINA’S THOUGHTS ON EXTERNALISING
Katerina: I’d like to thicken a bit something that
emerged from our last conversation, which is
that there are two aspects of narrative practice
that have been particularly useful and fruitful for
me in our conversations. The first is our
consistent insistence that problems are outside
of me, particularly when we made perfectionism
as a problem and as something that had had
extraordinary impact on my life. And the second
is when we began to document different ways
that the habits, attitudes and intentions of
perfectionism had impacted on how I could be
more active in my life. That was new and unique
for me.
For the first time, our conversations
positioned me so I could consider and take a
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 stand about life and develop values and
responses. And actually … I’m finding myself
again needing to come back to the kind of
vigilance that we had earlier… I need to be
constantly on the lookout for new tactics of
perfectionism. I think it’s really useful, and
I really appreciate having a particular theme and
continuity that I can keep coming back to.
Shona: When you were describing the importance
of findings ways of speaking which enabled you
to position consistent problems outside of you,
you said that was the first time that it had
happened in your life. You particularly named
perfectionism as one example. I’d be really
interested to understand more about what that
began to make possible in your life. What sorts
of things did speaking of problems as outside of
you, make possible? What effects did that have
on your thoughts of who you are?
K: At the time when we first started having
conversations, my sense of who I am was very
fragile indeed. I was so immersed in my shame
and sense of failure that to start considering that
anything could be outside of me and not
automatically be a product of my own awfulness
suddenly gave space for me to consider ‘what do
I think about this’. Before that, I was so
immersed in it that there wasn’t even the space
to consider if I had an opinion about the
different forces that were in operation in my life.
S: How significant was this, that through this way
of speaking, perfectionism and particular forces
that were in operation in your life became more
visible? Can you say a bit more about that?
K: It was significant because it linked me back to
the times in my life prior to being so vulnerable.
Starting to see some of the forces affecting my
life as cultural constructs was significant too.
Our conversations connected me back to ways of
thinking and talking that had been part of my
life before … it was such a relief, in a sense, to
be able to engage my intellect.
It was also significant in that it cleared a
space for my values to emerge again. I had
known that there are cultural forces that
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influence women’s lives. I knew this at an
intellectual level for a long time. But actually
being able to make the connection that me, this
actual physical me, and these actual physical
emotions, and this actual body, were as
vulnerable to these cultural forces as anyone
else, was huge. Until that point I’d always
thought that somehow, because I knew about
these cultural forces, that somehow I ought to
be not at risk of them.
S: When you had the realisation that these were not
only academic considerations, but that your life
was/is, as we all are, shaped and constantly
shaped by such cultural forces, what difference
did this start to make? What did that make
possible?
K: This meant that I could start looking at my life
differently. I could look at the way cultural forces
did and didn’t suit me. And I could do this, not
as part of a self-engrossed intense therapeutic
journey, but from a pure personal responsibility
approach.
S: Can you tell me more about the difference
between a ‘self-engrossed intense therapeutic
journey’ and ‘a pure personal responsibility
approach’?
K: Yeah … once we had identified that it was
certain cultural forces that were manifesting in
my life, then I could step away from self-
engrossed, I could step away from internal self-
assessment, or an intense ‘personal development
therapeutic model’ and instead start to
investigate the social forces at play in my life.
The more we had the conversations, the more it
was possible to see the forces as being outside
of me.
S: I know you have described how this new way of
looking at your life also enabled you to connect
with others, which means you were not isolated
in your own thoughts and understanding of what
was going on. In moving away from self-
assessment and being self-engrossed, it was
a move towards connection with others.
Is that right?
K: Yeah, absolutely, and the very act of exploring
the impact of various social forces on my life was
an act of commitment to a community
as well as to myself. Coming into these
conversations was like ‘I am engaging with the
world again’. We started with the idea, ‘Well, hey,
let’s just assume that perfectionism or ‘eating
disorder’ is something that exists outside of me
and that has its own way of operating. And let’s
assume that maybe there’s me and I might have
some ideas about this that are not the same’.
I love that as an image because it just sparks
my interest, it sparks my engagement.
S: How do you think these conversations
contributed to you having your own ideas more?
K: Partly because I find them instantly interesting.
It was a delight to have my interest involved in
something that was relevant to me, but just not
quite me. And the release of that constant
attempt at being responsible for everything was
really beautiful.
S: How did these ways of speaking contribute to
a release from responsibility for everything,
Katerina? How do you think that happened?
K: It’s almost like it changed my sense of space.
I vividly remember the day you said, ‘Well, if
perfectionism could be a dance, what would
it look like?’ I also remember the other time
you said, ‘As a dare, if you can, just let these
ideas filter through without you doing anything –
these new ideas that we’ve talked about today
where perfectionism might be a theme that
might have real impacts on your life – well you
don’t have to do anything about that, you could
just leave it, just let these ideas filter through’.
I remember you said ‘dare’ and it was like an
invitation to connect with my spirit, my
independence and my choices. It was really
stimulating.
EXTERNALISING CONVERSATIONS BEGAN TO
MAKE SEVERAL THINGS POSSIBLE
In re-reading these extracts from our
conversations, it is possible to consider just what
externalising conversations made possible for
Katerina.
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1. It made it possible for Katerina to name
certain life forces that were dictating her life
– these forces were effectively dictating
directions she took in life, dictating her view
of self, shaping her sense of identity. The
forces were very active in discrediting any
ideas or actions Katerina was taking to
reclaim her life from these forces.
2. Naming and researching the consequences
and impact of these forces in all areas of her
life created spaces for Katerina to gradually
gain small distances from the impact of
these forces. Through inviting Katerina to
take a look at the consequences of these
forces, she was able to decide for herself
what she thought.
3. Gradually, Katerina took her own position
in response to these forces. In response to
reviewing the habits of ‘unloving eating’,
Katerina once said, ‘You are really interfering
with what I want’, and ‘I’m so over this’.
In this way, she began to claim spaces of
her own.
4. In these spaces of her own, Katerina was
able to give expression to ideas she had, and
hopes she had, for her life. She was able to
stake a claim on values that were important
to her: ‘I want relief from exhaustion’, ‘I want
to be able to live in the world again’, ‘I want
my life, my capabilities, and joy’, ‘I can meet
challenges’, and ‘the forces do not have to
succeed’.
5. In speaking about these hopes and
preferences, many doorways opened. These
doorways enabled my enquiries to focus on
the preferences Katerina had for her life. In
this way, externalising conversations opened
the doorway for the development of other
stories about Katerina’s life, of her preferred
stories of identity. Stories that had been
subordinated by powerful forces began to be
noticed and became the focus of our
conversations.
I would like to highlight a point that became
very clear to me through this work. In conversations
with Katerina, it was very important to always
engage with parallel stories. On the one hand, broad
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externalising conversations about perfectionism (the
problem) made so much possible and have ongoing
application in response to recurring forces in
Katerina’s life. At the same time, it has been
critical to focus our attention on Katerina’s efforts
to reclaim her life from these forces. In this way,
I was always interested in Katerina’s responses to
what she was going through. I was also vitally
interested in the meaning Katerina gave to each
step she took.
Narrative practitioners focus on a ‘double-
listening’, so entry points for new or neglected
aspects of Katerina’s life were consistently being
listened for and asked about. Regardless of the
degree to which Katerina shared stories of
experiences of failure as a person, I was careful to
also focus my interest on any responses Katerina
was making. Such enquiries led to drawing out
actions taken in daily life and the values these
actions were an expression of. In this way, other
stories of life were discovered and developed – and
these multi-stories began to take shape parallel to
the dominant story-lines.
AN EXAMPLE OF PARALLEL STORY
DEVELOPMENT
As perfectionism became slightly less pervasive,
and as Katerina gained some small distance from
this force, it became possible for her to identify tiny
moments that represented other experiences of life.
We began to explore these moments of difference,
times when Katerina could just begin to dare to
notice when perfectionism was not operating in the
same way, or when the ‘sense of how life should be’
was not operating as strongly as it sometimes did.
I began to ask Katerina to tell stories about these
times of difference.
Early on, one of the times of difference that
Katerina noticed was an experience of playfulness.
One of the first stories that she told was a moment
when she’d had an experience when she didn’t feel
under the operations of perfectionism – this
happened while she was brushing her teeth. She
was brushing her teeth one day and noticed that her
little finger was not holding the toothbrush like all
the others fingers were. This little finger was instead
pointed upwards and, as she focussed on this and
then began to wiggle it around, a sense of fun and
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playfulness was clearly present. In the following
transcript, Katerina explores the significance of
taking small steps which then become the basis of
alternative story-lines. Katerina described these
moments as ‘the smallest possible steps I take
when in the grip of constant thought’.
LEARNINGS ABOUT LITTLE STEPS
Katerina: I think it was particularly powerful to be
moving as we did between actions and what
they might connect me with. What was amazing
was that there was nothing that I had to do, it
was things that I was already doing, and how
I ascribed significance to that.
Shona: Does an example come to mind? Can you
think of a small story about this where you
actually responded in an active way to things or
aspects that were really important to you?
K: I come back to the time we wrote a list of the
smallest possible steps I could take that
resisted what perfectionism might be having me
do, or that just supported me in living my life.
S: Why do you think it was important for us to
write the smallest of smallest of steps that you
were taking?
K: It’s important to remember what my life was like
at that point, I was mainly in bed. More than
that, small is where it starts. It was delicious to
actually think, ‘Oh well, sometimes when I think
I’m frozen, I manage to move my little finger’.
If I’m locked in what perfectionism’s done to my
idea of body worth, or of relaxation, then for me,
it’s significant to say, ‘Bollocks, I just want to
see what happens if I wiggle my finger’ …
Using minute actions as examples and then
writing them down cleared a space for me to
wiggle the finger again next time I was frozen.
I could feel, ‘I am linking into something that is
being done here, something is being done about
this sense of absolute paralysis’.
S: And who was doing the doing?
K: I was doing the doing.
S: And how significant was it to bring those stories
forward?
K: It was bringing me to life. I’m taking actions
that only I can know how significant they are.
And I’m knowing that they’re significant
because a process, a person but also a process,
is showing me that. We’re unfolding this, and it
made it possible for me to trust that actually
I’m not stuck here forever because steps are
being taken. When we then linked these minute
actions to my values that had a history, then I
could start to identify that I was doing my
values, doing my beliefs. And that, in the end,
revolutionised how I could relate to people.
Starting on that small scale, really linked me to
a whole other set of values around compassion
and valuing small steps.
S: In continuing to pay attention to very small
steps but very hard-won steps, and noticing how
these are linked to values, what do you think
you are making possible for yourself? How is life
different?
K: It’s becoming easier and easier to make
decisions. and to choose the next course of
action. It’s a cumulative sense that I’m a person
and body that engages in these particular ways.
When I’m vulnerable now, I can actually almost
be carried by the collection of my own actions
and beliefs. I’m much less vulnerable to be
swept into self-destructive behaviours or just
abysmal fear, anxiety stuff.
In focussing on those tiny moments of life when
Katerina was responding to practices of
perfectionism, other accounts about her life began
to emerge. At every opportunity, I would ask
Katerina: ‘Well, what might you call that? What
might be some names that describe what you’re
talking about?’ Just as there were very many names
given for the different operations and ways in which
perfectionism worked, Katerina also began to
identify many names for these alternative
experiences of life. A theme of ‘playfulness’
emerged out of focusing on these tiny moments of
difference. And, as you can tell, there was a sense
of fun in this. In this way there was parallel story
development through our work together.
Some of the emerging stories that were named
as significant by Katerina and more fully developed
over time, include:
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• yearning to be in the world again
• getting relief from the exhaustion
• non-judgemental curiosity
• creating places of safety
• enjoying myself
• navigating the territory of being in the world
• rising to the challenge
• wanting to be me.
A significant counter-story I would like to share
involved noticing and appreciating beauty. Katerina
would delight in telling very beautiful stories. These
included stories of times when she got well enough
to go and sit out in the sunshine in her back
garden. She would describe how she had been able
to focus on the leaves on the trees and derive a rich
sense of enjoyment and pleasure from this. Katerina
also began to notice and re-tell times when she had
a sense of revelry or joy, or a connection with the
natural world that was not ruled by perfectionism.
Conversations about this became incredibly
important.
Katerina described these alternative physical
expressions as subversive acts. She said that this
was ‘political’ for her – that she was putting a
political value on playfulness and joy. In the face of
the life-threatening experiences she was going
through, a counter-story developed of ‘subversion in
playfulness and delight’.
TAKING CARE IN THERAPEUTIC CONVERSATIONS
Initially, perfectionism was so active in every
aspect of Katerina’s life that even our conversations
were at risk of being sabotaged by it. Over many
years, Katerina’s experience had enabled her to gain
a comprehensive understanding of perfectionism
and how it worked. I thought Katerina’s
understandings could help. I was interested in
consulting Katerina about what she knew about the
operations of perfectionism, and this enabled us to
speak about ways that perfectionism might infiltrate
our therapeutic conversations. I was interested in
ways that therapeutic conversations could be
safeguarded from the workings of perfectionism and
the steps I could take towards this hope. Some of
Katerina’s understandings that became the basis of
discussion and influenced what took place in our
conversations, included:
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 • Perfectionism operates in the realm of ideas.
• Perfectionism can put a rigid freeze on any
initiative.
• Perfectionism is never satisfied with what’s
achieved – blame is implicit.
In the beginning of our conversations, any time
that Katerina took a position clearly or made a
definitive statement, she would say that she was at
risk of that opinion being critiqued by the operation
of some form of judgement. Steps she took to re-
claim her life were often subject to ridicule and her
preferences could be quickly disregarded. Through
discussion with Katerina, I explored ways of
responding to perfectionism’s presence in
therapeutic conversations. I’d like to share some of
the practices I engaged that helped circumnavigate
such intrusions.
• I paused regularly to ask about the effects of
our conversations. Sometimes Katerina would
choose to take a break to stretch, get a drink,
or move around.
• Other times I took care to notice the pace of
my questions. I learned that if I went too
quickly or if I jumped ahead of Katerina,
if we got excited about some new
developments, that this could leave Katerina
vulnerable to judgement, perfectionism, and
critique.
• I developed the practice of regularly making
editorials (summaries of new steps or recent
understandings using Katerina’s exact words
followed by a question) as a way of
influencing the pace of the conversation.
Asking a question at the end of each editorial
provided an opportunity for Katerina to
consider what was of significance to her –
to help restore a preferred sense of herself.
This process seemed to provide a focus for
Katerina’s ideas and preferences.
• Wherever possible, I became interested in
any actions, or small steps that Katerina had
already taken that could provide an example
of whatever value, hope or wish that was
being spoken about. This identification of
small steps contributed to Katerina
recognising and then further developing the
skills required to support her life.
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• Using the written word to develop documents
and declarations has been very significant.
Sometimes we deliberately created
documents that were incomplete. Naming
letters and documents as works in progress
provided some protection from judgement
and critique. I’ll include one of these
unfinished documents here:
RISING TO THE CHALLENGE
Katerina’s knowledges about her life.
Skills Katerina uses in living her life.
• Noticing spaces of ‘quietly welcoming’.
• Noting times of being non-judgemental.
• Experiencing thinking: ‘The Katerina that
wants to come out is worthy’.
• Remembering that worrying will not help.
• Reminding myself that the habits are
likely to hang around and to not be fazed
or distressed when they do.
• Noticing that these actions and thoughts
reflect rising to the challenge. They
are acts of resistance. They are a
celebration. They are another dimension
altogether.
REFLECTIONS
In this paper, I have tried to convey a range of
ways in which narrative practices opened
possibilities for Katerina to deconstruct the
influence in her life of cultural forces such as
perfectionism. I have also tried to describe how this
work involved parallel story development. Extended
externalising conversations about perfectionism took
place at the same time as the development of
alternative story-lines around playfulness and
appreciation of beauty. Throughout the entire
process, we tried to make the most of every
opportunity for Katerina to put her own hopes,
intentions and values into words, as this clearly
contributed to restoring a preferred sense of herself.
It seems significant to close with Katerina’s
words:
Our conversations positioned me so I could
consider and take a stand about life and develop
values and responses.
 I felt I was being skilled by this process of
noticing small things. I got skilled in noticing my
own actions that give me pleasure. I could say what
it felt like to see and smell that beautiful rose.
Through this process I began to feel myself as a
person of ethics again. I found another angle to
what I did and how I did it.
RELATED READING
Gremillion, H. (2003). Feeding Anorexia: Gender and
Power at a Treatment Center. Durham: Duke
University Press.
O’Grady, H. (2005) Woman’s relationship with herself:
Gender, Foucault, and therapy. Hove: Routledge.
Welch, S. D. (2000). A feminist ethic of risk (rev. ed.).
Minneapolis: Fortress Press.
White, M. (1997). Narratives of therapists’ lives.
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www.narrativetherapylibrary.com

Narrative Therapy Library Website

The International Journal of Narrative Therapy and Community Work

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2007 No. 3 www.dulwichcentre.com.au