Imposter syndrome is the experience of feeling inadequate, doubting your abilities and competence, and worrying about being ‘caught out’. You may fear that if only people around you knew the truth about you, they would discover that you are a fraud, and an imposter – just pretending to be a ‘real’ professional.
But, of course, those who experience this are in fact real professionals, who are objectively successful. They’re not pretending – they have done the hard graft, and got the certificates (and scars) to prove it. Yet despite their successes they suffer from persistent self-doubt.
Imposter syndrome is very common amongst all professionals, with stats suggesting that 70% of people will experience this at some point in their working lives. Rates are particularly high amongst therapists and healthcare professionals. A recent review of studies of imposter syndrome amongst doctors found rates of 22-60%. This can have serious consequences and lead to anxiety, depression and burnout.
The irony is that imposter syndrome and professional self-doubt have more of an impact on those professionals who care the most about doing a good job, and who have more self awareness. Those who are less concerned about how effective they are, or who lack insight into their limitations, don’t have this problem.
Cognitive biases in imposter syndrome
Imposter syndrome is related to two main cognitive biases (or thinking errors):
- Attribution bias: My successes are due to luck, my failures due to lack
This attribution error means that people struggling with imposter syndrome don’t accurately attribute their performance to their competence. They believe that any successes are due to external factors, such as luck, or the support of others. This often shows up as “yes, but…” responses when people try to reassure them that they’re actually doing okay.
Imposter syndrome also means that people don’t apply this same attributional process to their failures – rather than seeing these as (at least in part) due to external factors, they attribute the entire cause to something internal, i.e. their own lack of competence.
On the other hand, they tend to apply the opposite principles to others – others’ successes are due to internal qualities and competence, and their failures are due to external factors such as bad luck, or systemic pressures. With these double standards in play it’s almost impossible to feel good about yourself and your accomplishments.
This is the inverse of the “fundamental attribution error” – a cognitive bias believed to have an evolutionary role in protecting our self-esteem. For most people most of the time it is helpful for us to believe that our achievements are due to our personal strengths, and our failures due to external factors such as other people or bad luck. This protects our sense of self when we are faced with failure. However, it can also stop us reflecting on our role in events and preventing us from making the same mistake again.
Reflexive capacity is key in industries such as healthcare. We are dealing with complex issues where there is often a huge amount of uncertainty. It’s vital that we are open to learning from mistakes and being responsive to what’s in front of us. So the irony is that the very thing that makes us good at what we do (the ability to self-reflect, take responsibility for our actions, and be responsive) leaves us open to imposter syndrome and self-esteem damage.
- Selective attention: Noticing everything I don’t know
When we’re caught up in imposter syndrome our brains focus on all the gaps in our knowledge and skills. We compare ourselves to what we think others know, and always find ourselves lacking. We lose sight of the expertise we do have, and make unfair and unrealistic comparisons.
In complex fields such as healthcare, this can be overwhelming as there is a forever growing body of knowledge. It’s impossible to know everything all the time, but we often feel that unless we do we are failing. This focus on what we don’t know, rather than what we do know, can be paralysing. This graphic illustrates this problem well:
Making friends with your imposter
While professional self-doubt can lead to anxiety, low mood and burnout, the irony is that in moderation it can actually make us better at our jobs. For example, research in the psychotherapy field has shown that moderately high levels of professional self-doubt are associated with stronger therapeutic alliances, greater therapeutic change and better patient outcomes. However, this is only the case when self-compassion is also present.
Being effective at work is not the same as being an “expert”. In fields where these is a lot of complexity or uncertainty (such as anything to do with the human mind or body) being effective requires us to be responsive, open to feedback, and able to reflect on errors and mistakes. On the other hand, adopting an “expert” stance can lead to having a fixed mindset and being closed to feedback that doesn’t fit with the paradigms we are attached to.
Of course we need to embrace our expertise, skills and knowledge, but we need to hold them lightly so that we are open to learning and developing. Being over-confident and overly attached to our ways of thinking can make us brittle in the face of complexity, and ultimately make us more prone to mistakes or misjudgements.
If we can start to see that self-doubt, in moderation, can actually make us more effective professionals, we can start to drop the struggle with the discomfort it causes. If we can make room for these doubts, we can begin to view them as potentially helpful messengers and as signs that we really care about our work. We can make use of this to doubt our professional approach, but not our professional worth.
How to respond to imposter syndrome and professional self-doubt
The key to responding to imposter syndrome and professional self-doubt is noticing our cognitive biases at work and cultivating self-compassion. So the next time you become aware of your imposter showing up try these steps:
- Say hello – allow these thoughts and feelings to be present. They’re already here, don’t fight them, just let them be.
- Notice your mind at work. Can you identify any thinking errors? Are you over-estimating how much others know compared to you? Are you minimising your contribution to your successes, and magnifying your responsibility for failures? Are you catastrophising or mind-reading?
- Acknowledge that your mind is doing these things to try to protect you and that this discomfort is a sign that you really care about your work and the impact it has. It’s painful because you care – if you didn’t it wouldn’t bother you.
- Remind yourself that it’s healthy to question your approach – it means you can be open to learning and improving.
- Remind yourself that you are worthy and valuable and good enough – no matter what you do or don’t achieve at work.
- Offer yourself a gesture of self-compassion, as you would to a friend. That might be kind words, a supportive gesture or doing something that makes you feel good. You can learn more about building self-compassion here.
If imposter syndrome and professional self-doubt are having a significant impact on your mood, wellbeing and functioning at home or at work this might be a sign of burnout. Check out my Burnout Toolkit (designed for doctors, nurses and therapists) – particularly the Self-Doubting Pattern – for more helpful strategies. Do also consider reaching out for support from loved ones or a professional such as your GP or a therapist.
