Within our competitive culture, some perfectionistic students do well, whereas others are overwhelmed. The personal characteristics of these perfectionistic students should not be construed as positive or adaptive perfectionism. A distinction is made between perfectionism and the pursuit of excellence. The intensity of the anxiety at the core of perfectionism is destined to have negative emotional, relational, and even performance consequences. Clinical observations over a 35-year practice of psychotherapy provide data for understanding the developmental trajectory of perfectionism and its psychological roots in particular attachment relationships, modes of affect regulation, and meanings ascribed to mistakes. A clinical vignette illustrates these constitutive factors and suggests an approach for school psychologists and other mental health professionals for launching and supporting a process of recovery. Perfectionism is a self-esteem issue, involving a desire to be perfect, a fear of imperfections being seen as evidence of personal defects, and an emotional conviction that such imperfections make one personally unacceptable. Because perfectionism arises in a relational environment of conditional acceptance, an antidote is something that counteracts this. Creating an environment of acceptance, described here, can provide such an antidote. The potential power and inevitable limitations of the school psychologist's role are also illustrated.