The Silent Struggle: Navigating Imposter Syndrome as a Therapist
Dear Colleagues,
We've all been there. You're sitting across from a client, offering a carefully considered explanation on the what, why, and how of their pain, and a quiet, persistent voice in the back of your mind whispers, "Who are you to be offering this advice? What if you're wrong? What if you’re a bad therapist?" And if you think the way I used to think, that answer somehow directly reflects your personal value as a human. (Maybe I’ll write about that journey in another post.)
This feeling has a name: imposter syndrome. It's the nagging feeling that you are not as competent as your outside image shows. It can be despite your grades in university, despite the evidence of positive client outcomes, and despite the referrals from those clients. And in our profession, it's a secret struggle that many of us face, no matter our degree, the vast amount of continuing education we have, or how many years we've been in practice. I have personally come a long way in this, but I still exist with some anxiety before each new assessment.
Are therapists, in particular, more susceptible to this feeling? I don’t have an easy answer for that.
The Unique Pressures That Fuel the Imposter
Our work, by its very nature, creates a perfect storm for imposter syndrome to thrive:
The Weight of Responsibility: Each person looks to us for their physical and (let’s be honest) emotional well-being. This responsibility is a heavy one, and it's natural to question if we're truly up to the task, especially with complex, chronic, or difficult cases. How excited are you to get a textbook ankle inversion sprain?!? And how often does that happen? HA!
The Endless Learning Curve: The world of health is constantly evolving. There's always a new technique, a new study, or a new approach to master. This can leave us feeling like we're perpetually behind, no matter how much we learn.
Professional Isolation: Due to the nature and confidentiality of our work, we can't simply debrief with friends or family about a difficult case. For some, this isolation can amplify feelings of inadequacy, as we lack the casual validation and shared experiences that many other professions enjoy. I find this is especially true for practitioners who are not working with an active team.
The "Healer" Archetype: Society often places therapists on a pedestal, viewing us as perfect, infallible experts. I am not saying it’s right, but it does happen. This external pressure can lead us to believe we must live up to an impossible standard, making any perceived mistake feel like a fundamental failure. In my early years of practice, I used to take on that individual’s health as my responsibility and their success or lack of success felt like it had a direct impact on my perceived self-worth. A horrible feeling.
Comparison Culture: Whether consciously or unconsciously, we compare ourselves to our colleagues, the professors who taught us, or the "gurus" in our field. This can lead to the false conclusion that everyone else has it figured out, and we're the only ones still struggling.
How Imposter Syndrome Manifests in Our Practice
The voice of the imposter can influence our day-to-day work in subtle and not-so-subtle ways:
Over-Preparation: You find yourself spending hours on a single patient's chart, or researching every possible differential diagnosis, driven by the fear of being "caught unprepared." This can also translate into the insatiable need for knowledge stemming from this intense feeling of inadequacy. For me, this used to be my driving reason for taking more courses. Now, I take courses because I’m genuinely curious and enjoy playing in the rehab realm.
Discounting Success: A patient gives glowing feedback, and you immediately attribute it to their own hard work or luck—anything but your own skill and knowledge.
Anxiety Over Mistakes: You fixate on minor errors in your technique, convinced they are a sign of your incompetence. Let’s face it, people only have one body, and unlike a car, it’s irreplaceable. The anxiety makes sense.
Under-Charging or Undervaluing Services: You struggle to charge what you're worth because deep down, you don't feel worthy of it. As a younger therapist I remember how this would feel. Now as a more experienced therapist, and as a business owner, it drives me absolutely nuts to have this conversation with other therapists. “You do not offer a discount service and therefore do not offer a discount price!”
A Constant Need for Validation: You find yourself regularly seeking reassurance from colleagues or supervisors, even when you know the answer. I also think this happens more with the transition from school to practicing on your own, and rightly so. Suddenly, there is no one telling you that your assessment, rehab plan, or manual techniques are correct. You’re just out there…in the wild…hoping you’ll find your way before something with teeth bites you!
Practical Strategies for Silencing the Inner Critic
The good news is, imposter syndrome is a feeling, not a fact. Here are some strategies to help manage it:
Normalize the Feeling: Recognize that this feeling is incredibly common in our profession. It's often a sign of a conscientious and empathetic therapist who genuinely cares about the people they are working with. I have a saying when working with students, “It’s important to empathetic. But don’t be so empathetic that you’re pathetic - then you’re not helping anyone!”
Is functional empathy a thing? I feels like it should be a thing.Focus on Progress, Not Perfection: The goal is to be effective, not perfect. Acknowledge and celebrate the small wins—the patient who found relief, the successful assessment, the positive feedback, no matter how small. It makes an impact for both you and your patient.
Know Who is Responsible for Healing: Acknowledge that we are not healing the individual in front of us. It is their body doing the healing and we are helping create the best environment with the tools we have. The body is in a constant state of flux. How that person feels and heals depends on more than a few rehab interventions. Their stress, hydration, sleep, nutrition, daily activity, medications, previous history, family history, even their drive to the clinic can all impact the process. You are not healing them, they are healing themselves!
Lean into Your Support Systems: Talk to your supervisor (even if they are no longer in that roll), peer consultations, and professional network. These are the spaces where you can safely process difficult cases and receive the validation and feedback that combats professional isolation. It really doesn’t need to be difficult cases either. Sometimes you just need that feedback consistently to get your brain out of the imposter rut.
Embrace a Growth Mindset: View "mistakes" not as proof of your inadequacy, but as valuable learning opportunities. In my experience, a patient unexpectedly getting worse means their body or tissue did not respond in the way I anticipated. This doesn’t make it a mistake but it does provide me with more information (throws up a red flag for further investigation) and maybe even referral. If patient expectations are managed at the beginning of your treatment plan by giving them the appropriate education and making them an active part of the process, the blip in the road is only a blip, and you work through it together.
Practice Self-Compassion: Treat yourself with the same kindness and understanding you offer your clients. You are human, you are learning, and you are doing your best. I might be more alone in this belief, but I feel it is both ignorant and arrogant to believe you can help everyone. If your best isn’t working, refer on. At the end of the day, it is about the patient getting results and it’s alright if that is not with you. I highly suggest you allow yourself that permission.
Find Your "Base": You can be an effective therapist when you become proficient at those base tools. Focus on mastering your core skills first and find confidence in your proficiency with them before worrying about knowing every single technique. I still go back to my base skills when things are getting complicated. They are not the most efficient, but they are effective.
The life of a therapist is uniquely challenging, yet profoundly impactful. By acknowledging the quiet voice of the imposter and proactively building self-awareness and support systems, we can move beyond self-doubt and into a space of confident, authentic, and enduring practice. You are a valued and skilled professional, and you belong here. If you have doubts, throw me an email and we’ll chat about it.
Author:
Nikki Smith
Owner, Certified Athletic Therapist