Impostor syndrome: what it is, signs and how to work with it in therapy

Marta is 31, an architect, and two months ago she was promoted to project lead. In her first session she says she has slept badly since the promotion, checks every drawing three times and answers emails at eleven at night. When you ask why she thinks they chose her, she doesn't hesitate: “Because the other candidate left for another company. It was luck.” She has ten years of excellent performance reviews behind her and is still convinced that one day someone will realise she isn't up to the job. What she describes has a name, and it is far more common than she thinks: impostor syndrome.

This guide is written for psychologists who meet it in their consulting rooms, and also for anyone who recognises themselves in Marta. It covers what impostor syndrome is and why it isn't a diagnosis, how it shows up, the cycle that keeps it going, who it affects (psychologists included), how to assess it and how to work with it in therapy.

What is impostor syndrome?

The APA Dictionary of Psychology describes it as the situation in which highly accomplished, successful people paradoxically believe they are frauds who will eventually fail and be unmasked as incompetent. Clinical psychologists Pauline Rose Clance and Suzanne Imes named it the impostor phenomenon in 1978. They described it in a group of female college students who, despite excellent grades, felt that most of what they had achieved was down to chance or some kind of error.

What defines it is the gap between what the person has shown they can do and what they believe about themselves. They can collect degrees, good reviews and satisfied clients without any of it touching the underlying feeling: “I'm not as good as they think.” Praise, instead of reassuring them, often makes the fear worse, because it raises the bar they will have to keep pretending to clear.

Outside academic writing it became known as impostor syndrome (often spelled imposter syndrome), and that is how almost everyone searches for it. In this article we use the terms interchangeably.

Is it a disorder? What the research says

No. Impostor syndrome is not a diagnosis in the DSM-5-TR or in the ICD-11. It is a way of experiencing your own performance, with fairly recognisable thoughts, emotions and behaviours, ranging from passing doubts to distress that shapes major life decisions.

The most cited systematic review on the subject, published in 2020 in the Journal of General Internal Medicine by Bravata and colleagues, pooled 62 studies with 14,161 participants. Its findings help put it in perspective:

• Prevalence depends on how you measure it. Figures ranged from 9% to 82%, mostly depending on the questionnaire and cut-off each study used. Any headline claiming that “70% of people have it” is oversimplifying.
• It affects men and women, and it appears at every age studied, from adolescence to late-career professionals. Rates were particularly high among ethnic minority groups.
• It rarely comes alone. It often coexists with depression and anxiety, and it is linked to poorer job performance, lower job satisfaction and burnout, including among clinicians.
• There were no treatment studies. None of the studies published up to that point evaluated a specific intervention.

Signs of impostor syndrome

Hardly anyone walks into therapy saying “I have impostor syndrome”. They come because of anxiety, exhaustion, a promotion they can't enjoy, or because for months they haven't dared to take the next step. These are the signs worth exploring:

• Attributing success to external factors: luck, timing, help from others, the exam being easy or the client “not noticing”.
• Taking failures personally, and globally. A mistake isn't a mistake: it's proof that people should never have trusted you.
• Fear of being found out. The feeling that you're fooling everyone and that sooner or later it will come out.
• Discounting praise. “They're just being nice”, “they don't know how hard it was”.
• Over-preparing or leaving everything to the last minute, two sides of the same anxiety that we'll see in the cycle.
• Constant comparison with colleagues who seem to know more and try less.
• Avoiding challenges: not asking for a raise, not applying for a post, turning down a talk or putting off opening your own practice “until I have another master's”.
• Not enjoying achievements. The relief is short-lived and the next test arrives straight away.

Seen from the outside, many of these behaviours look like virtues: responsibility, modesty, a drive to improve. That's why they go unnoticed for years, sometimes even by the person themselves.

Types of impostor syndrome: a popular classification

If you look for information, you'll often find five “types” of impostor: the perfectionist, the expert, the natural genius, the soloist and the superhero. They come from a book by educator and author Valerie Young and capture styles that do turn up in therapy: the person who can't allow a single mistake, the one who needs to know everything before starting, the one who thinks that struggling with something means they're no good, the one who never asks for help and the one who has to shine in every role at once. They can help a client recognise themselves, but they are not a research-validated classification.

The impostor cycle: why success doesn't calm it

Clance described a pattern that explains why piling up successes doesn't cure impostor syndrome and can even strengthen it. It is known as the impostor cycle and it has five steps:

1. A task that matters comes up: an exam, a presentation, a new case, a promotion. Anxiety, doubt and worry kick in.
2. The person responds in one of two ways. Either they over-prepare, far beyond what the task requires, or they put it off and then work against the clock.
3. The task goes well and there's a brief sense of relief.
4. The credit goes elsewhere. If they over-prepared, success is explained by the excessive effort (“anyone would manage with that many hours”). If they left it to the end, by luck (“I got away with it this time”). The praise doesn't count.
5. The sense of being a fraud grows. The next task looks riskier than the last one and the cycle starts again.

The trap is in step two. Over-preparing works in the short term, so it sticks, and at the same time it prevents the person from finding out what would happen with a normal amount of effort. The evidence that their ability is enough never arrives. In therapy, mapping two or three of the client's recent achievements onto this cycle is often the moment they understand what's going on.

Who it affects and why

Impostor syndrome mostly appears in capable people working in demanding settings where they are evaluated often. It's common among students on tough degrees, PhD candidates, healthcare professionals, people who have just changed jobs or sectors, and people who are the first in their family to go to university or reach a senior role. Transitions (a first job, a promotion, starting a business, a change of role) are what trigger it most.

When it comes to its origins, there are more hypotheses than certainties. The APA notes that later studies found it in men as well and that early family conflict and a lack of parental support may play a part. In therapy you often see families that were heavily focused on achievement, early labels (“the clever one”, “the responsible one”), affection that seemed to depend on results, or the feeling of not fitting into a new environment.

Is impostor syndrome more common in women?

It was first described in women, and for years it was talked about as a women's problem. Later research doesn't support that idea: Bravata's review found it common in both sexes, and the APA itself points out that men are susceptible too. Context, however, does matter. Being a minority in a field, getting less recognition or having to prove more than your colleagues all feed self-doubt, and that explains part of the differences some studies find.

Impostor syndrome in psychologists and therapists

Few professions bring together as many ingredients for impostor syndrome as ours. Psychotherapy deals with results that take time to show, with clients who improve for many reasons at once, and with an uncertainty that doesn't go away with experience. Add the jump from university or a master's to running your own practice, and the ground is well prepared.

Some thoughts that come up again and again in psychologists starting out:

• “If my client knew this was only my third panic disorder case…”
• “I can't charge 60 euros for this. What if I don't help them?”
• “I need more training before I can see trauma, couples or teenagers.”
• “They cancelled. They must have realised I don't know what I'm doing.”

That last one deserves a number. In Swift and Greenberg's meta-analysis of 669 studies and 83,834 adult clients, the average psychotherapy dropout rate was 19.7%: one in five. It also varied with factors such as the client's diagnosis and age, the treatment setting and the therapist's level of experience. Clients dropping out happens to every therapist. It's a reason to review the case (our guide to therapy adherence covers how to reduce dropout), not proof that you're a fraud.

What protects you most is what we would recommend to a client: talking about it. Clinical supervision and peer consultation groups normalise doubt and turn it into specific questions about specific cases. It also helps to separate two things the impostor feeling mixes up: clinical competence, which is built through training, practice and supervision, and confidence, which usually arrives quite a bit later. If you're also noticing accumulated fatigue, irritability or thoughts of quitting, go over the signs of psychologist burnout, because the two problems feed each other.

For self-employed psychologists, part of the impostor feeling lives in the business side rather than the clinical one: setting a price for sessions, charging for missed appointments, saying no. Our guide to psychologist session fees gives you reference points for setting your rates sensibly, and our page on software for self-employed psychologists explains how to run your practice without admin eating up your day.

Impostor syndrome, perfectionism, self-esteem and anxiety

Impostor syndrome shares ground with other problems and often coexists with them. Telling them apart helps you decide where to start:

Perfectionism is where the overlap is greatest: many impostors are perfectionists, and the over-preparation in the cycle is pure self-demand. The difference lies in the focus. The perfectionist fears the mistake; the impostor fears that the mistake will give them away. With low self-esteem, the difference is one of scope: someone with impostor syndrome can feel fine about themselves as a partner, friend or parent and doubt only their professional competence.

If the doubt has spread to everything, if there is low mood most of the day, loss of interest, changes in sleep or thoughts of death, the priority is to assess for depression. And if the worry spills over from work into health, family or money, it's worth ruling out generalised anxiety disorder.

How to assess impostor syndrome

Assessment starts in the interview. A few questions that open the topic without labelling it:

• “When something goes well, what do you put it down to?”
• “What goes through your mind when someone praises your work?”
• “How do you prepare for an important task? How much time do you spend on it compared with your colleagues?”
• “Have you ever not applied for something because you were afraid you wouldn't be good enough?”
• “If others could see how you really work, what do you think they would find out?”

The Clance scale and other impostor syndrome questionnaires

Several instruments exist to quantify it. The most widely used is the Clance Impostor Phenomenon Scale (CIPS), which Pauline Rose Clance published in 1985: 20 statements rated from 1 (“not at all true”) to 5 (“very true”), so the total ranges from 20 to 100, and the higher it is, the more frequent and intense the impostor feelings. The APA also lists the Harvey Impostor Phenomenon Scale (HIPS, 14 items) and Kolligian and Sternberg's Perceived Fraudulence Scale (PFS, 51 items).

Two caveats. First, there is no universal cut-off, which is why prevalence figures vary so much from study to study. Second, a high score is not a diagnosis. The questionnaire helps put a number on something vague, lets the client see it in writing and allows you to compare the score at the start with the score a few months later. The CIPS is copyrighted, so check the terms of use before you add it to your practice.

Alongside the questionnaire, explore what tends to come with it: symptoms of anxiety and depression, signs of burnout, sleep quality, and whether the person is relying on alcohol or other substances to keep up the pace.

How impostor syndrome is treated in therapy

There is no specific protocol backed by clinical trials, and it's worth telling the client so clearly. What we do is apply techniques that work for neighbouring problems, mainly from cognitive behavioural therapy, to each person's particular pattern. These are the most useful pieces for treating impostor syndrome.

Giving it a name

Learning that what's happening to you has a name, that it was described almost fifty years ago and that it happens to very capable people already brings relief. Psychoeducation includes the impostor cycle applied to the client's own achievements: what the task was, how they prepared, what they credited the result to and what they did with the praise.

Reviewing how success is explained

At the heart of impostor syndrome is an attributional style: success is external and temporary; failure is internal and permanent. Cognitive restructuring puts that explanation to the test. A simple exercise is to split a recent achievement into a pie chart: what percentage was luck, what was help from others and what was their own decisions, preparation and experience. Almost always, the slice of luck ends up much smaller than the client claimed at the start.

Behavioural experiments to break the cycle

Challenging thoughts isn't enough if the behaviours that maintain them stay the same. Behavioural experiments target over-preparation and avoidance:

• Preparing a presentation in half the usual time and writing down beforehand what you expect to happen. Afterwards, comparing the prediction with the outcome.
• Submitting a report without the third round of checks.
• Asking a colleague or supervisor for specific feedback on the work instead of waiting for the dreaded verdict.
• Applying for something you'd been avoiding and seeing what happens.

The point is to discover that reasonable effort produces reasonable results, which is exactly the evidence that over-preparation was preventing.

The evidence log

People with impostor syndrome tend to have a very selective memory: they remember mistakes in full detail and forget their achievements. An evidence log corrects that bias. Every week the client writes down facts, not opinions, that speak to their competence: a problem they solved, a specific comment from a client, a deadline they met. Rereading it before an important task helps them answer the thought “I can't do this” with data.

Self-demand, self-compassion and values

Often you also need to work on standards: what doing each task “well enough” means, and what it costs to keep the bar so high. Self-compassion helps people treat their own mistakes the way they would treat those of a colleague they value. And approaches such as acceptance and commitment therapy teach them to notice the thought (“I'm having the thought that I'm a fraud”) without obeying it, and to keep moving towards what matters even if the doubt hasn't completely gone.

Group work, whether a therapy group, a supervision group or a peer group, has a special effect here: hearing other brilliant people describe exactly the same feeling dismantles the idea that “it only happens to me”.

How to overcome impostor syndrome day to day

If you've recognised yourself in this article, these steps usually help:

• Name it when it shows up. “That's the impostor talking” puts some distance between you and the thought.
• Separate feeling from knowing. Feeling like a fraud doesn't prove you are one. Ask yourself what evidence you have.
• Keep the evidence. A folder with thank-you emails, reviews and concrete achievements.
• Talk about it with someone you trust or with a mentor. You'll be surprised how many people say “me too”.
• Try doing something just well enough on a low-stakes task and notice the result.
• Be careful with comparisons, especially on social media: you're comparing your backstage with everyone else's shop window.

When to seek professional help

Feeling unsure when facing a new challenge is normal. It's worth seeing a psychologist when impostor syndrome:

• Leads you to turn down opportunities, promotions or projects you want.
• Makes you work far more hours than is reasonable for months on end.
• Comes with intense anxiety, sleep problems, persistent low mood or exhaustion.
• Pushes you to rely on alcohol or other substances to cope.
• Has lasted months or years and doesn't change however much you achieve.

How to document work on impostor syndrome

Because progress is gradual and clients tend not to see it, it's worth keeping a written record of:

• The scale score at the start and at each review, with the date.
• The map of the cycle with two or three real situations from the client's life.
• Each behavioural experiment: the prediction, what happened and the conclusion.
• Associated symptoms (anxiety, mood, sleep) and how they change.
• The work or academic context: changes of role, appraisals, deadlines.

Rereading that record with the client after three or four months is often an intervention in itself: it's a list of evidence they built themselves.

Impostor syndrome in your practice with My Psico Agenda

My Psico Agenda doesn't assess or treat anyone: that's your job. What it does is organise everything around the treatment, which in a case like this is quite a lot:

• The clinical history, session by session. In the private notes for each session you keep the map of the cycle, the scale scores and the outcome of each experiment, and you can see progress without digging through paperwork.
• The evidence log, in the client's hands. You upload the template to “Patient files”. It starts as “Hidden”; when you switch it to “Visible”, the client finds it in their own space, under the “Documents” tab, and on their record you see “Seen” with the date they opened it.
• The same time every week. With “Recurring therapy” you book the client's regular slot, and they get a WhatsApp reminder 24 hours before with buttons to confirm or cancel.
• Data instead of gut feelings, for you too. Each client's statistics show “Total sessions”, “Attendance” and “Cadence”, and in “Statistics” you see monthly therapies, unique patients, cancellation rate and sessions per patient, compared with the previous period. If you're one of those people who think “nobody comes back”, there's your answer in numbers.

If you're just starting out, the Semilla plan costs €4.99/month + VAT and is designed for exactly that: up to 15 patients, clinical history with session notes and 20 automatic WhatsApp reminders a month. As your practice grows there's Junior (€19.99) and Senior (€29.99), and centre plans start at €99.99/month + VAT. All of them come with 1 month free, no card needed and no lock-in. Our page on software for psychologists has the full details.