Looking in mirror
by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way
Whereas feelings of being a fraud or impostor are commonly associated with being a new social worker, these psychological states are actually endemic to clinical social work practice across all stages of experience. Some social workers talk openly about feeling like an impostor, while others keep their feelings private and to themselves. Regardless of how the experience is handled, it is difficult to negotiate and even harder to find our way out of it.
The term impostor syndrome was originated in 1978 by two clinical psychologists, Dr. Pauline R. Clance and Suzanne A. Imes. The term was coined in an effort to capture the psychological fear of being found out, of walking around feeling as if one is faking it, or generally feeling as if one’s own knowledge and skill are simply being performed, rather than authentically held and felt.
While Imes and Clance called this sensation “impostor syndrome,” D.W. Winnicott spoke about the concept of a true or false sense of self. He declared that developmentally, children sense what their caregivers most want and shape themselves according to these perceptions. Rather than evolving organically and authentically, children censor their emerging selves in the hopes of pleasing their caregivers and subsequently securing the attachment. It is argued that once a false sense of self is performed, accessing a truer sense of who we are becomes incredibly difficult.
Whether it is referred to as a feeling of fraudulence, impostor syndrome, or a false sense of self, it is a psychological state that makes our work difficult, uncomfortable, and dissatisfying. In fact, estimates show that 40% feel this way, while other research has found that nearly 70% of all workers have had this feeling at one point in their professional lives. Perhaps the reasoning behind feelings of inauthenticity is inexplicable in social work, but I actually think there are some real reasons we are left feeling this way. Further, I think the illumination of these reasons might help liberate us from feeling like clinical impostors.
Theory
The fact is that most of us graduated from social work schools where the training was problematically generalist. The courses often end up feeling like survey courses. Each week is dedicated to a particular theory or intervention. For example, one week is spent on CBT, object relations, or motivational interviewing. We are assigned three articles or one book chapter, and the exploration of the topic is done. The discontinuity between topics from week to week makes it hard to internalize any one way of thinking.
We then enter work settings that claim to use one type of intervention or theory. For example, many settings that work with childhood abuse now almost exclusively use TF-CBT (trauma-focused cognitive behavioral therapy). Many substance abuse settings rely on motivational interviewing or the 12 steps. You probably didn’t read much about these interventions in school, and you are basically left with a manual, and perhaps a few trainings and worksheets. Between you and a client, the fact is that you don’t religiously use TF-CBT or any other theory, for that matter. We all practice, to some extent, eclectically. This is a by-product of both our clients’ needs and the nature of how we were taught in school - a little of this and a little of that. The mismatch between what is expected of us and what we are actually doing leaves us feeling as if we are faking it. We are not sure whether we are getting it wrong, but we know that we aren’t doing as we are told.
Paperwork
The levels of paperwork we are required to do are invariably burdensome. While this is problematic, the most problematic aspect of it is that paperwork almost always requires us to create some sort of fiction. More and more, paperwork asks for target treatment goals and progress notes that correspond with these treatment goals. Further, these treatment goals are supposed to be crafted in increasingly quantitative ways; counting the presence of symptoms and ideally symptom reduction as the treatment weeks pass.
The expectations completely fly in the face of how humans actually function. Improvement cannot always be quantitatively measured, rarely happens in a linear fashion, and is nominally goal oriented. Progress is unpredictable, treatment goals are difficult to articulate, and symptoms are not experienced numerically. So, we are left to either treat our clients according to the demands of the paperwork, which leaves us feeling like we are somehow abandoning them, or we treat our clients in a way that feels more authentic and we end up falsifying or editorializing the work we did in order to best fit the note. Either way, we are left feeling less than honest and more than uneasy.
Supervision
The fact of the matter is that, when we receive supervision in our workplaces, which many of us do, it is difficult to be honest with our supervisors. First, much of our supervision is spent reviewing tasks, paperwork, and adherence to agency standards and rules. Second, supervision often demands us to act as if we are much more loyal to the agency treatment modality than we usually are. Supervision often asks us to downplay the intimate realities of our treatment relationships, because discussing these truths leaves our supervisors fearing that we are unboundaried and unethical. We rarely discuss the ways in which we self-disclose in supervision, and we certainly stay away from talking openly about how strongly we feel about our clients.
Just like children who offer up a false self to maintain their attachment to their caregivers, we often offer up a false image of who we are professionally in order to keep the peace at our work, and to keep our jobs.
Impossible Tasks
I truly believe that among the most powerful reasons that we are often left feeling fraudulent as social workers is the fact that we are asked to do too much with too little - acting like we actually can pull off what is often impossible or untenable. For childcare workers, visiting a child’s home one time to determine whether or not to open a case is not enough. But with 30 other cases, one visit must suffice much of the time. For medical social workers, discharge planning is typically something to satisfy the standards for discharge paperwork, but rarely represents the reality of what patients need when they leave a hospital. For inpatient mental health settings, with acutely suicidal clients, we must act as if the three to five days of treatment (allowed by insurance) will be adequate enough for someone to be re-set and committed to life.
We are actually, often, asked to fake. We are then surprised by the many ways in which we feel fraudulent, keeping these shameful feelings to ourselves.
Don’t Hide
What I know, with a decent amount of certainty, is that feeling like an impostor takes a toll. What I also know is that many of us are doing even more than our best, rendering us anything but fraudulent. Our sound intentions, attunement to our clients’ idiosyncratic needs, endless flexibility, and creativity all render us highly authentic. Even when we do our work drained and depleted, we are truly trying to straddle multiple systems while remaining engaged with clients who desperately need us.
Perhaps rather than continuing to internalize feelings of falseness, we can begin to articulate the multiple external factors that conspire to make us feel "less than." In recognizing and naming these forces, a truer sense of self can evolve. Because the truth is that every time we sit with a client and bear witness to the complexity of their internal worlds, while seeking to make scarce resources go as far as we can, we are social work warriors, not impostors.
Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She provides more of her clinical perspective and tips for developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.