Updated: Jan 29
"There's an imposter among us!"
In early 2021, one of the most popular games was Among Us. In this game, all of the players look the same with different colors and hats, and they all have one mission — complete tasks to keep the machines operational and figure out who the Imposter is before that player can sabotage everyone else. If the crewmates could figure out who the Imposter was first and eject them, they would win, but if they didn't figure it out in time, the Imposter would win.
Sometimes new cash based physical therapy private practice owners can feel the same as the Imposter in the game, always on edge, being worried about being found out & ejected. Imagine, showing up in a room full of other therapists, who all have similar degrees and educational backgrounds as you do, we all dress the same (khakis and scrubs), and your goal is to figure out how to start and grow a successful physical therapy private practice before they can figure out what an imposter you are.
I think the big difference between the actual game and the comparison to how we feel in real life is that everyone feels like they're secretly the Imposter and it's only a matter of time before they get figured out.
Pretty stressful right? And not exactly helpful for you wanting to work towards your goals.
Let's talk about what it is, how it appears, and how to get rid of it once and for all!
What is Imposter Syndrome?
Imposter syndrome was first described by psychologists in the 1970s as a phenomenon that "occurs among high achievers who are unable to internalize and accept their success. They often attribute their accomplishments to luck rather than to ability, and fear that others will eventually unmask them as a fraud."
It leads to feelings of fear, anxiety, panic, depression, etc because new physical therapy private practice owners with symptoms of this syndrome are often questioning themselves, asking things like...
"Who am I to be trying to do this?"
"What right do I have to do this?"
"I don't have enough experience."
"I just graduated, I'm not good enough."
"Who is going to pay me?"
"This is a huge risk."
"Can I really do this?"
Having these self-limiting beliefs or questioning oneself can come as a result of growing up in an environment where there was a lot of emphasis on achievement — where being "good enough" and "being worthy" often went hand in hand with getting high grades, performing well in sports or other activities, and being above average in as many areas as possible.
There's also a lot of pressure in the graduate programs for therapy degrees. There are often very strict rules about grades and if a certain grade is not achieved, you will be excused from the program. And once you graduate, you only have a certain number of tries to pass the national licensing exam.
I know where I went to school at Ithaca College, the rule for our program is that the student was not allowed to have more than two Cs within the graduate program. I really struggled during our first semester in neuro classes and I was beyond terrified of being kicked out of the program, which led to me studying all day every day as hard as I possibly could. And don't even get me started on how I felt during practicals 😖 I now believe wholeheartedly that IC has one of the best physical therapy programs out there based on my clinical experience and helping patients, but man, was it stressful.
And after school of course comes finding a job where there are certain productivity requirements, often 85% or above (one SNF I was at had a 95% productivity rate), and if you don't meet those, there can be consequences for your job.
So for a lot of us, coming out of these environments and having societal pressures to be perfect or close to it, has led to a lot of feelings that are then translated to anything we want to do in life. Specifically in this instance, starting a practice.
If people find out we are starting a physical therapy private practice, what are they going to think? What if they think I'm not good enough? What if I try to help a patient and it doesn't work? Do I really have enough experience to practice on my own? What if I charge someone for services and they're unhappy with their experience? What if I don't make enough money or find enough patients?
What if they find out I'm a total fraud because I've never opened a practice before?
How Imposter Syndrome Is Keeping You Stuck
Speaking of school, remember how for exams and practicals, you would study until your eyes crossed (I distinctly remember doing this) and try to retain the highest volume of information and specific details as possible, so just in case a particular thing came up on the test, you would know what to do? Like you wouldn't feel like you had completed everything or finished something until you knew every single little thing that could possibly come up.
Or another way that this shows up for me is that I won't start any creative projects or purchase a new piece of tech until I research every last detail and compare and contrast all of the options. I know I almost didn't start working with patients until after I took ICE's Fitness Athlete Essentials course (awesome btw) and I had to talk myself into starting to see patients and doing the best I could. I almost didn't help a patient with a pelvic floor issue because I'm not pelvic floor certified.
The thing is, you will never know all of it. Nobody does. We just don't have the mental capacity to know all of the things all of the time 100% perfectly. And you don't have to. What's important is that you know how to ask the right questions and analyze the answers you receive, in order to make the best plan moving forward.
As a recovering perfectionist, I've also struggled with feeling like everything I do is never enough. (Raise your hand if your daily task list also tends to be about 50 tasks long 👋) I could finish 99% of what I set out to do in a day and feel like like I failed, especially if I made a small mistake or something didn't turn out exactly as I had planned. Check out this interview here with my friend and fellow PT, Tyler Burke, where he talks about how he has learned to deal with failure even after preparing for all possible scenarios.
Where does this "failure focused" mindset leave me? Feeling down in the dumps, despite all that I had accomplished, which just compounds day after day after day. And what's the point in feeling that way?
Basically, imposter syndrome for me often leads to me feeling sad, worked up, exhausted, and keeps me from making progress towards my goals. Sound familiar?
How To Finally Get Rid Of Imposter Syndrome
Now that we have talked about different ways imposter syndrome can show up and affect us, how do we take care of it?
Recognize it — when you find yourself asking the questions I mentioned above or doubting your ability, call yourself out. Write it down, say it out loud.
Reframe it — Then two of my favorite questions to ask myself and my clients are "Is that absolutely true?" and "Does that thought help me or hinder me?"
Start to think like an imperfectionist — in the book "How To Be An Imperfectionist", the author focuses on creating opportunities for mini or micro successes. As opposed to always thinking on the macro level/about the destination/about the result, focus on taking small steps, succeeding at those small steps, and focusing on making progress forward, even inch by inch. For example, if you're working on building relationships in your community, maybe focus on reaching out to one new person per day. And all you have to do is call them. Then that is success and you succeeded in the day.
Use these small wins to build up your confidence — As you start to redefine your definition of success and where you're at in your journey, you'll begin to focus more on what you have accomplished vs what's missing. I think this also allows you to speak more from your experience aka not being a fraud because you literally experienced the thing.
Check out my post here where I go into more detail about shifting your mindset to get and keep clients on your caseload.
Last pro tip, I get asked a lot about treating patients "on your own" and how that can be scary and new and "what if...?"
The first thing I usually ask the practitioner is if you would treat that patient any differently on your own vs in the clinic/hospital/etc. The answer is typically no. Your evaluation and plan of care wouldn't be any different. And if you needed help, you would ask for it! The only difference is that practicing on your own, you won't have another therapist right there, but luckily for us, we live in the age of the internet and have other clinicians literally at our finger tips to ask for help (and that's also one of the perks of working with a therapist as your business coach 😉)
If you have a patient on your own with a diagnosis you haven't worked with before, my answer is always the same — I'm honest with my patients. If there's something that I don't feel confident with treatment wise (looking at you TMJ) then I will tell them that I haven't treated that before but I'm more than happy to research it and help them come up with a care plan where we will both learn together and I'll hold their hand every step of the way, or if they'd rather, I can help them find someone who can help. This has helped me keep 2 out of 2 patients so far where this came up. People appreciate honesty and your willingness to help despite not knowing it all (who does really).
I also try to remember all the times I have helped people, whether it was truly clinical improvement or just being the support system they needed or the coach they needed to help them create space in their life to focus on their health. There are so many more ways that we help people than just diagnosing and fixing the physical problem, and that's just as valuable.
Truthfully, you will always have times of doubts, that's just human nature. We want to be good, we want to help, and you'll wonder if there's something more you could have done. But all you really have control over is your effort and trying to do your best, not perfection. That's all we ever ask of our patients, so it's time to start asking the same of ourselves.