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Navigating Imposter Syndrome

“You don’t know what you don’t know”

This is something we have all undoubtedly seen or experienced ourselves. Witnessing the look of terror unfold in a student’s eyes as they are asked a question or faced with a situation with which they do not know how to respond. A deer in headlights, frozen in time and unsure of what move to make next.

Moments feel like minutes as the student uncomfortably searches the deep corners of their memory for an appropriate answer. Nothing discussed in his years of education comes to mind. A sense of panic continues to overwhelm the young clinician. “I don’t know… I don’t know… what do I say!? Maybe I don’t know enough to help this person” he worriedly thinks to himself.

The student’s apprehension and dread is not lost on the patient before them. Luckily, the patient realizes this and offers a calming, “Oh, don’t worry! I’ve asked the same thing to at least five of my doctors, and none of them seem to have an answer for me!”

A nearly audible sigh of relief exudes from the student. “Well that was close, I had literally no idea what to say” the student thinks.

If this scenario sounds at all familiar to you, I can assure you that you are not alone. The concept of “imposter syndrome” takes many forms and often affects all of us to varying degrees. Understanding and managing such feelings of inadequacy can be an immense struggle for many young coaches and clinicians who lack confidence in their current abilities and knowledge.

For the sake of clarity, what exactly is “imposter syndrome”?

It is generally defined as doubting ones’ abilities and feeling like a fraud. More often than not, this feeling occurs disproportionately in high achieving individuals who find it challenging to accept their successes and readily identify areas of weakness. Because this belief pervades many highly motivated and intelligent individuals, it is readily seen across well-intentioned coaches and clinicians as well.

The first question becomes: “Is it a problem? Isn’t it a good thing to be humble and challenge yourself to do better?”

Undoubtedly, the quest for personal and professional advancement relies heavily on self-reflection and improvement. However, to what extent do feelings of perceived inadequacy and fraudulent capabilities limit our advancement?

In some instances, a degree of self-doubt and self-reflection can serve a protective mechanism. This could be seen when working with a medically complicated client with whom you do not fully understand their conditions or capabilities. In this event, some level of apprehension and desire for further information and knowledge is quite healthy and warranted due to incomplete information. This is merely appreciating ones’ current knowledge limitations and seeking to improve upon them.

Alternatively, there may be a scenario where there is copious amounts of available information, but the clinician or coach is not comfortable acting upon it due to a lack of perceived certainty or confidence. A simple example could be a clinician performing an initial shoulder evaluation, but who does not feel confident or comfortable educating the patient on possible contributing causes, modifications to current training, or relevant exercises to be performed independently. Oftentimes in such a situation, the relevant information and capabilities are present, but the clinician is unable to access and/or organize them in a meaningful and comprehensible way for the client. In times of stress, we often fall back to what we know best, even if it is not necessarily the most appropriate for all situations.

The above scenario harks back to the idea of “paralysis by analysis”. When offered too much information, sometimes it can be extremely challenging to categorize and prioritize which information is most relevant and which needs to be acted upon. In a world where high-achieving individuals are expected to make complicated associations with highly complex human beings, this becomes exponentially more challenging.

Our educational systems have inadvertently engrained a desire to find the “perfect answer” in all situations. Unfortunately, such an answer does not always exist outside the realm of multiple choice questions.

As highly reflective humans, we often experience an immense fear of being wrong, of not having the “right answer”, or “not being good enough”. This harps back to our desire to do the best in all situations, even when there is incomplete information. The unrelenting availability of misinformation, social media highlight reels, comparison to colleagues and others, and appearances versus reality further exacerbate this cycle.

This begs the question, “what can we do to manage and learn from imposter syndrome?”

The first and most relevant piece of advice is to seek out a mentor or colleague who is willing to give honest and constructive feedback. If you are your own worst critic already, it’s a fair assumption that you should get feedback from a non-biased source.

Perhaps your strengths and shortcomings are not as significant as you once thought. Perhaps your perceived inadequacies or gaps in knowledge are just a normal part of the process of learning and growing. Perhaps your sense of self-doubt can serve as a potent motivator when aimed in the appropriate direction.

The best thing any newer clinician or coach can do is to find such a person to give them a realistic perspective of where they are now, what they do well, and what they can benefit to improve upon. Additionally, such mentorship provides accountability and an accelerated path to further improvement by learning from other’s trials and tribulations.

“You simply do not know what you don’t know”

Accepting this fact is both disconcerting and liberating. We must understand and appreciate that it is impossible to acquire all of the wealth of information in the world. However, this does not mean we should not seek additional knowledge. Rather, we have to refine our strategies for seeking and storing new relevant information.

Whether you are a coach, a clinician, or a totally different capacity, we are always working from incomplete information. The quest to improve in our field is to enhance our decision making processes based on the snapshot of information we do have available to us.

How do we then learn to make better decisions without complete information?

In reality, we learn constantly through the process of trial and error. The more mistakes you make, reflect upon, and learn from, the more refined your decision making processes will be in the future. That one instance of touching a hot stove is likely enough to make you learn never to do it again. That one really embarrassing moment in high school is probably enough to prevent its reoccurrence in the future.

Our brains work in intricate ways to identify and adapt based on common patterns and cause and effect relationships. The more experiences we analyze, the more accurate our pattern recognition and anticipatory processes can become. Working with patients and clients is no different. We are likely to draw more useful information from the strategies and methods that do not work as compared to those that do.

This is no different than the idea of looking at constructive criticism as a gift rather than an afront.

We can help to manage this lack of complete information by performing “safe-to-fail” experiments readily and often.

Safe-to-fail experiments offer us the ability to test our theories and analyze the results. They hold us accountable and keep our biases at bay (hopefully!). If we have a strong belief that x is causing y, then we find a way to test it in an environment that minimizes potential risk.

A simple example would be if we think an individual’s lack of knee extension is contributing to their knee pain with running, we might prescribe them interventions with the intent of improving their knee extension range of motion. If the knee extension range of motion improves, we can then assess whether their symptoms with running improve as well.

In the instance that their knee extension improves and their pain also reduces, we might assume a causal relationship.

In the instance that their knee extension improves but their pain remains unchanged, we might still assume a correlation, but not a direct causation. Further testing and experimentation will be warranted.

Last, but most definitely not least, appreciate the beautiful honesty of: “I don’t know, but…”

Contrary to popular belief, it is perfectly acceptable to utter the words, “I don’t know…”. We cannot possibly have all the answers, nor should we pretend to. “I don’t know, but…” serves as an opportunity to discuss possible contributions or other information that may be relevant in determining an appropriate course of action. Allowing your clients to hear the realm of possible contributions can also serve as a means for them to make relevant associations on their own. The better the client’s understanding of your thought processes and course of action, the more buy-in and compliance he or she will likely display.

“Imposter Syndrome” incessantly prods us to question ourselves and our actions. As long as we continually seek unbiased feedback, reflect and learn, and perform safe-to-fail experiments, we can better temper and mold these thoughts into a driver of professional development.

-Michael Reinhardt PT, DPT, Site Director- R2P Germantown

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