Therapy for Perfectionism Starts Where Praise Stops Working
By Martha Fernandez, LCSW
“Échale ganas.” Give it your all. Plenty of families in the Valley say it to their kids before a test, a tryout or a first job, and it has carried a lot of people a long way. It is good advice. For some people, it quietly turns into a rule that nothing less than everything will do.
That rule has a name. Perfectionism is not the same as high standards. Perfectionism is high standards plus the belief that falling short proves you are not enough. High standards say, “Let’s do this well.” Perfectionism says, “If this is not flawless, I am a failure.”
The second voice is surprisingly common, and it is growing. A meta-analysis by Thomas Curran and Andrew Hill, published by the American Psychological Association in Psychological Bulletin, looked at 41,641 college students in the United States, Canada and Britain. Between 1989 and 2016, socially prescribed perfectionism, the sense that other people expect you to be perfect, rose 33 percent.
Edinburg knows ambition. This news site reported in September that the UTRGV School of Medicine has graduated more than 300 physicians since it opened in 2016. Each of those doctors got there on high standards. So did the teachers, nurses, small business owners and volunteers who hold this community together. Ambition is not the problem. The problem starts when the praise stops working.
When praise stops working
Perfectionism is rewarded right up until it is not. The perfectionist gets the promotion, the scholarship and the thank-you at the meeting. But the good feeling fades in a day, sometimes an hour, and the next standard is already higher. Praise becomes a short break from the pressure rather than a reward.
Then the costs arrive, usually in this order: sleep, judgment, relationships.
The judgment part is the one people miss. A 2026 CEREVITY report, 62% of High-Achievers Report Worse Decisions While Hiding Strain (2026), reviewed 261 high achievers who sought therapy through the CEREVITY network. Sixty-two percent reported a noticeable drop in the quality of their decisions during stretches when they were hiding the strain. The strain was not the problem. The hiding was.
Perfectionists hide well. Admitting they are struggling feels like one more thing they did not do perfectly.
Three questions to ask yourself
1. When I do something well, does the relief last longer than a day?
2. Would I let a friend talk to themselves the way I talk to myself after a mistake?
3. What am I afraid would happen if the people around me saw me struggle?
If your honest answers are “no,” “never” and “everything,” it is worth paying attention.
What treatment involves
Therapy for perfectionism does not try to make anyone lazy or careless. It works on the rules underneath the behavior. A therapist helps you notice the rule (“one mistake means I failed”), test it against your actual life, and try small experiments with “good enough” to see what really happens. Most people find that the sky does not fall, and that the energy they spent guarding against every flaw comes back to them.
Good treatment also makes room for self-compassion, which is different from lowering the bar. It means speaking to yourself the way a good coach would: honestly, and on your side.
When to ask for help
Ask for help when perfectionism costs you sleep most nights, when you are putting off tasks because you cannot do them perfectly, when you are irritable with people you love, or when you notice your decisions slipping and keep it to yourself. Those are not character flaws. They are signs that the rule has outgrown its usefulness.
Échale ganas is still good advice. Giving it your all can include asking for help before you run out.
If you or someone you know is in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline. Martha Fernandez, LCSW, is a licensed clinical social worker and co-founder of CEREVITY, a private-pay concierge network of independent licensed clinicians built for high achievers. She is the author of Wired to Burn: A Therapist’s Guide for High Achievers Running on Fumes (2026). Learn more at cerevity.com