Sarah Framarin, M.Ed., CCLS, CTRS
Child Life Specialist III, Pediatric Procedure Unit Baystate Children's Hospital, Springfield, MA
In 2008, I vividly remember walking the hallways of the Franciscan Hospital for Children. I was a newly minted child life volunteer, and I just couldn’t believe my great stroke of luck. “Me? Really? I can’t believe they think I’m qualified to be a volunteer here.” I have had echoes of this feeling before. Prior to my time at Franciscan, I felt that same feeling when I was accepted to the university where I did my undergraduate work. I thought, “It must be because I applied to such a small program, they probably needed to fill those slots.”
Throughout my early adulthood, I tended to explain away any success I had. With each milestone came a growing sense of fear, “When am I going to be found out?” I wondered when ‘they’ would realize their mistake, the ‘they’ being whoever had hired me, given me a chance, or a new opportunity. This fear culminated when I was hired for the child life position that I currently hold. The then-manager of the program was well-known in our field, and I had been cautioned by my internship supervisor as to her extremely high standards. So, of course, when she hired me my first thought was “Wow, I tricked her! I can’t believe I fooled her into thinking that I would make a good child life specialist!” That was nearly nine years ago. Now, I know that the feeling that I was experiencing has a name: the impostor phenomenon.
The Impostor Phenomenon
The Impostor Phenomenon, or IP, as I’ll refer to it here, was first formally identified by Suzanne Imes and Pauline Rose Clance in 1978. They presented IP as something experienced primarily by “high achieving women.” More recent studies, however, have discounted the importance of gender when it comes to the experience of IP feelings (Rohrmann et al., 2016). To put it simply, the impostor phenomenon describes an individual’s feelings of fraudulence despite objective evidence to the contrary. In lay society, this feeling is commonly referred to as the “Impostor Syndrome,” and in academic literature as the “Impostor Phenomenon.” Even when termed the more clinical sounding “Impostor Syndrome,” IP is not a clinical diagnosis found in the DSM or ICD-10. Many who experience IP believe that they are alone in feeling fraudulent about their skills and abilities when in fact, almost 70% of high-achieving individuals experience impostor feelings at some point in their careers (Hirschfeld, 1985). There are also ‘prime times’ in a person’s life that impostor feelings may spike (Clance, 1985). A rise in impostor feelings is often coupled with significant transitions, such as the acquisition of a new job or a promotion. In preparation for writing this article, I assembled an ‘impostor timeline’ for myself. On this timeline, I listed each significant career milestone that I’d achieved over the past several years. Each spike in my own impostor feelings has correlated directly with a new promotion or responsibility in my educational or career journey.
According to Clance (1985), individuals that experience the impostor phenomenon typically exhibit at least some of the following characteristics:
- The need to be special or the very best
- “Superwoman” or “Superman” characteristics
- Fear of failure
- Denial of competence and discounting of praise
- Fear of and guilt about success
- Extreme over-preparation
- Procrastination and utilization of self-handicapping behaviors
Due to feelings of incompetence and self-doubt, some are hesitant to seek promotions or other advancement opportunities due to the fear of being ‘found out’, which has major impacts on career mobility. Such avoidance helps one avoid potential exposure as an impostor (Buchanan, 2006). Obviously, this has a very detrimental impact on our field if IP is preventing Certified Child Life Specialists from taking risks and seeking out opportunities for achievement.
Why Child Life? What the Research Tells Us
The reason I felt so passionately about diving deeper into this concept is because of my chosen profession. I was hard-pressed to think of another field so at risk for their practitioners experiencing the impostor phenomenon as I believe the field of child life is. A great deal can be learned from research on IP and how it is seen in other fields.
Being an Authoritative Figure
In a 2014 study, researchers looked at IP and its impact on college and research librarians. Librarians are often charged with playing a variety of different roles throughout the day. Of course, the same could be said for child life specialists. “Striving to be seen as an authoritative figure can lead to internal conflict when the librarian does not feel he or she is knowledgeable or experienced with the subject at hand. Furthermore, college and university librarians often serve as liaisons to faculty with more education and experience, which can exacerbate those feelings” (Clark et al., 2014, p. 255) Child life specialists are called upon to be authoritative in stressful healthcare situations with children and families. We are asked to identify what, in each situation, is the ‘best case scenario’ to facilitate coping through an experience. Oftentimes, we find ourselves in a new role, setting or assisting with an unfamiliar procedure. Even when we are familiar with the technical dynamics of what needs to happen for a patient and family, we are asked to speak authoritatively to physicians who likely are more technically educated and may be more experienced, which can spur self-doubt.
On the Job Learning
An additional finding of the study by Clark et al. (2014) noted that feelings of inadequacy resulted from minimal training coupled with high expectations of new professionals. It was found that many college and research librarians felt inadequate related to their heavy workload. One respondent stated that they had a feeling of not being able to give one hundred percent on any task or project (Clark et al., 2014) What a familiar feeling that is for child life specialists, with our time often being split between administrative tasks and patient care. I do not think I would ever characterize our education and training as ‘minimal’, however, there is a great deal of on the job learning that must occur, which can leave new specialists feeling unprepared by their education.
Recent studies of students in the dental, medical, pharmacy, and nursing fields showed that their impostor feelings were associated with perfectionism, burnout, and depression. (Henning, Ey & Shaw, 1998). For medical students, high ratings on the impostor scale were significantly associated with burnout, reporting high levels of emotional exhaustion, depersonalization, and diminished feelings of personal accomplishment (Villwock et al., 2016) Professionals who were in their first three years of work as college and research librarians had much higher IP scores than their more experienced colleagues. (Clark, Vardeman & Barba, 2014). A study of physician assistants revealed similar results, specifically that impostor experiences seemed to peak early in one’s career and tended to re-emerge at expected times, like with new promotions or challenges (Mattie et al., 2008).
There is a very high incidence of IP experience in both medicine and academia where the appearance of intelligence is crucial to success (Kets de Vries, 2005). By the very nature of these positions, medical and academic professionals are supposed to be ‘experts’ in their field. They have students, patients, or both for whom they are providing guidance. This fact has huge implications for the child life specialists that are academicians. A 2018 study of 28 physicians and their experiences revealed doctors are not spared from impostor feelings, and, for many, success, positive feedback, and awards did not mitigate their impostor feelings (LaDonna, Ginsburg, & Watling, 2018). Even those in advanced career stages were noted to be questioning the value of their achievements. Additionally, it was found that the culture of medicine is not conducive to discussing doubts, for fear of being perceived as ‘weak’. IP has also been found to be strongly associated with the fourth year of medical school and medical residents (Leach et al., 2018), supporting the idea that transitions are peak times for impostor feelings.
The Power of the Word “Specialist”
We can learn a great deal from a study of clinical nurse specialists and the impact of the impostor phenomenon. One of the many things that this study pointed out was the impact of having the word ‘specialist’ in one’s title (Sweeney Haney, Birkholz, & Rutledge, 2018). With clinical nurse specialists specifically, this word was thought to place a heavy burden on the individual who saw it as their duty to be an expert across all their job tasks.
A Broad Scope
As was evident in a study of new librarians entering their field, a lack of clarity in the scope of one’s position can contribute to IP feelings (Lacey & Parlette-Stewart, 2017). We are all too accustomed to competing demands for our time and resources and not having ‘enough’ time for either our patients or our projects. As familiar as we may be with our own defined scope of practice, there is so much nuance to the role of a child life specialist. At times, this makes our scope difficult to define and quantify. We are accustomed to ‘picking up the pieces’, pitching in wherever we’re most needed and sometimes we find ourselves doing something that we’d never dream we’d be asked to do as a part of our daily work.
Addressing the Impostor Phenomenon in Child Life Specialists
Both the academic research and lay literature are filled with strategies on how to address IP. I’ve done my best to condense that advice and highlight what I’ve found to be most helpful in my own experience.
Name Your Feelings and Talk About Them
If the feelings I’ve described are familiar to you, take the Impostor Test developed by Clance (1985). to see your IP rating. If it indicates you are experiencing IP, the next step is to talk about those feelings. Identifying and talking to a mentor to receive realistic feedback can be helpful (Sweeney et al., 2018). If you are not quite ready to say these things out loud to someone, journaling is another option (Roche & Kopelman, 2013).
Record Positive Feedback
To dissociate oneself from imposter feelings, it is important to take a step back when receiving praise or good news. If it is coming from a reputable source, we would do well to accept it at face value (Young, 2011). Evidence of positive feedback can be found everywhere once you start looking. Recommended strategies include jotting down verbal praise and saving items like thank you cards from patients and families. These can be kept in a folder or portfolio along with feedback from any formal evaluations. This collection can be looked at as a reinforcement for the individual struggling with impostor feelings and can also be used as hard evidence of success when it comes time for an annual review.
It may be helpful to remind oneself that it is appropriate to feel like a novice in any new position or role and eventually progress will be made to an expert level (Sweeney et al., 2018). It is also recommended to work from a growth mindset, rather than a performance mindset. With a growth mindset, errors are perceived as a natural part of the learning process rather than a personal failure (Molinsky, 2016).
Incorporate IP into Training
It is strongly recommended that IP be incorporated into orientation and training materials for students and new staff. For current staff, it can be part of ongoing supervision or integrated into annual competencies.
Time and experience are both mitigating factors for impostor feelings. If we can pinpoint exactly what behaviors or situations are increasing impostor feelings (talking to physicians, for example), we can create opportunities to make that behavior more familiar.
The Special Responsibility of Managers
Managers have the challenge of supporting those that experience the impostor phenomenon among their employees while likely dealing with some degree of impostor feelings themselves (Rohrmann et al.,2016). Managers should remain alert for signs of the impostor phenomenon in their employees, most notably: fear of failure, fear of success, perfectionism, procrastination, and workaholism (Kets de Vries, 2005).
Seek Therapy if Desired
The impostor phenomenon does not need to be a clinical diagnosis to merit exploration through therapy. Likely interventions of a therapist might include delving into an individual’s family dynamics and the early experiences which may have contributed to impostor feelings, as well as teaching cognitive techniques to address impostor feelings as they come up (Langford & Clance, 1993). Individual counseling or group therapy may be appropriate (Clark, et al., 2014). Even though impostor characteristics don’t necessarily require psychological treatment or prevent success, they do have an impact on one’s ability to enjoy their success and is therefore worth examining (Rohrmann et al., 2016)
Coming to Terms with the Impostor Phenomenon
When I first learned about IP, I stayed quiet. My experience of feeling like a fake had been a part of me for so long, it was a major piece of my identity that I had to disassemble. The moment that did push me into firm action against my own impostor feelings is crystal clear in my memory. It was around 2013 and I was reviewing something with my manager in her office. She offered me a compliment about my work, and I quickly began to demur, probably saying something like “Oh, well it wasn’t just me…” or “Anyone could have done that”. She stopped me, mid-sentence, and looked straight at me as she advised, “Just say thank you.” Even now, writing that, I must take pause and reflect. That seemingly simple statement changed everything, and it lines right up with what I have learned about IP. Though it took me a bit longer to internalize praise when I receive it, I never again have denied a compliment. Now, I just say “thank you."
Recently, a nurse that I work with asked me to speak to her clinical nursing students about child life via Zoom. There was that old voice again, asking, “What could I possibly have to say to these students?” Very quickly, I was able to remind myself that I have plenty to say to those future nurses.
Our field absolutely merits a more formal study of how the impostor phenomenon impacts child life specialists. I would hypothesize that we would see a spike of impostor feelings in the first few years of employment and subsequent spikes with new roles and transitions, as is seen in other professions. Knowing what we do, however, I wonder, would there be high IP scores throughout our careers just by the nature of our role? I was greatly encouraged when I saw that there was a presentation offered related to child life and the IP at the 2020 Child Life Annual Conference. The more the language of impostor-ism becomes commonplace in our field, the more equipped we’ll be to deal with these feelings as they arise.
Buchanan, L. (2006). The impostor syndrome: why do so many successful entrepreneurs feel like fakes? Inc., 28(9), 37-38.
Clance, P.R., & Imes, S. (1978). The imposter phenomenon in high achieving women: dynamics and therapeutic intervention. Psychotherapy Theory, Research and Practice, 15(3).
Clance, P.R. (1985). The Imposter Phenomenon: Overcoming the Fear that Haunts Your Success. Atlanta, GA: Peachtree Publishers, Ltd.
Clark, M., Vardeman, K., & Barba, S. (2014). Perceived inadequacy: a study of the imposter phenomenon among college and research librarians. College & Research Libraries, 75(3), 255-271.
Henning, K., Ey, S., & Shaw, D. (1998). Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Medical Education, 32(5), 456-464.
Hirschfeld, M. (1985). Is there an impostor in your office? Management Review, 74(9), 44-47