I’ve struggled with impostor syndrome on and off at various points in my life. It’s a bug that’s hard to quash. For me, impostor syndrome took the form of feeling like I needed more in order to be an authority. It was the way, when someone asked me a question, I led with: “Well, I’m just a medical student …” I thought, once I graduated medical school, or once I passed Step 3 and got my medical license, or once I graduated residency, or once I passed my boards, then I would finally feel like I belonged — like I had made it.
You see, medicine is set up this way — a never ending series of hoops to pass through. If you buy into this thinking, you will always believe you need something external to validate you — a degree, a coveted position. These external validations feel good for a while, but eventually, especially when you struggle with impostor syndrome, they lose steam. You’re back to feeling like you need another diploma on the wall. I am certainly not saying that physicians do not need to complete extensive medical training. The knowledge and skills we learn in medical school and residency are essential for practicing medicine. The thing is — we have to hold these accomplishments lightly, as opposed to grasping for them. The MD is one part of what makes me a doctor. What makes me a good doctor is how much I care.
I’ve seen many articles out there saying the key to beating impostor syndrome is to dispute those self-critical thoughts. As if you can talk yourself into believing that you are not an impostor! For me, this has never worked. In medicine (and, in life) there is always someone who has accomplished more and is seemingly higher up the totem pole. Acceptance and Commitment Therapy (ACT for short) is a type of psychotherapy that aims to teach psychological flexibility. ACT focuses on the techniques of mindfulness, acceptance and values-based living. I’d like to share some tips that I use myself and share with my patients about applying the principles of ACT to excel despite these thoughts.
1. Create distance from critical thoughts instead of fighting with them.
One simple technique is to create distance from the negative self-talk because it’s impossible to make it disappear completely. If you struggle with impostor syndrome, medicine can easily become a psychological system where you constantly need more diplomas or certifications to validate yourself or to feel like you can speak up. The self-defeating thoughts can get really loud. Instead of getting into an endless tug-of-war, try making space between yourself and the thoughts. There are many different ways to do this. One simple technique is to add the phrase “my mind is saying” in front of each negative thought. For example, if the day before giving a presentation you find yourself thinking you aren’t qualified, you would simply rephrase the thought to “my mind is telling me I’m not qualified.” This small shift in language draws your attention to the perspective that these thoughts are a creation of your mind. They do not define you. In other words, the content of your thoughts is less important than your relationship to your thoughts.
2. Connect with your values to spark inspiration.
Another technique for living with impostor syndrome is to be closely rooted in your own values. What type of physician do you want to be? Imagine it’s 20 years in the future, and one of your patients or colleague is interviewed. How do you want them to describe you? What do you want to be remembered for? Connecting with these deeper questions hones in on your values, can help clear out the noise of negative self-talk, and keep your internal compass pointed in the direction you want to go.
A special note for us type-A doctors: It’s easy confuse goals with values. Goals are concrete items that you want to achieve or have in the future. Values are desired qualities of action that you embody now, and on an ongoing basis. They are not about what you want to achieve. Values describe how you want to behave or act on an ongoing basis. You can live by your values whether or not you meet your goals. In my experience, when I focus on my values, it takes me away from comparing myself with others. When I pay attention to my reasons for doing the work that I do — alleviating suffering in my patients and helping others feel confident and successful — I can approach tasks that might seem nerve-wrecking, like giving a talk or submitting a paper for publication, with excitement and curiosity, as opposed to self-doubt and dread.
3. Record and reflect on your success to internalize accomplishments.
The first two techniques help to create distance from negative self-talk and enable you to connect with values as opposed to being overly goal-focused. These tools can help you stay in motion as opposed to stuck in the self-doubt of impostor syndrome. It’s also important to take time to reflect on your successes. Start a notebook and write down your past accomplishments. As you take on new challenges, add everything to it! Don’t feel shy — add even the smallest wins. This is something you should read once a week, and that you can also turn to during times of insecurity. You can also create a “successes” calendar on your smartphone, and add accomplishments daily. These practices will help you reflect on your achievements and eventually, to internalize them.
Impostor syndrome is an internalized social phenomenon. It keeps us looking outward instead of reflecting on and integrating our own competency and success. Living in our fast-paced, productivity-oriented world, and working as a physician is a recipe for getting stuck in self-doubt and comparisons. Getting off the treadmill of proving my worth to myself, and to others, is not a one-and-done task. It’s a constant practice to remember that this value can only come from inside me. Coming back to these techniques allows me to move forward in more confident and clearly-directed manner.
Pooja Lakshmin, MD is a board-certified psychiatrist and Assistant Professor of Psychiatry & Behavioral Sciences at the George Washington University School of Medicine. She is passionate about women’s mental health. You can find her on twitter @PoojaLakshmin. She is a 2018–2019 Doximity Author.
Citations
- Hayes, Steven C. “Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies.” Behavior therapy 35, no. 4 (2004): 639–665.
- Hayes, Steven C., Michael E. Levin, Jennifer Plumb-Vilardaga, Jennifer L. Villatte, and Jacqueline Pistorello. “Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy.” Behavior therapy 44, no. 2 (2013): 180–198.
