PPRNet Clinical summary: Therapists’ Professional Self-Doubt

About 6% of patient outcomes can be attributed to therapist factors (their self-concept, coping style, empathy, capacity to manage countertransference). One of those factors may be professional self-doubt (PSD), which refers to a therapist’s self-questioning about their professional efficacy, their uncertainty, or lack of confidence. However, therapists’ PSD turns out to be a complicated factor to research, and findings appear contradictory. Some studies found that trainee therapists with higher PSD had patients who experienced poorer outcomes. But other studies found that more experienced therapists with higher PSD had patients with better outcomes. Novice therapists may experience PSD as a sense of being an imposter, whereas experienced therapists may experience PSD with humility and motivation to do better. Another complication has to do with the therapist's self-concept and interpersonal insecurity related to attachment style. A negative self-concept among therapists may make the experience of PSD more difficult and interfere with therapeutic progress. Finally, professional coping strategies may interact with PSD to influence the therapeutic alliance and patient outcomes. Research suggests that “constructive coping” (being reflective) may buffer the negative impact of PSD, whereas “non-constructive coping” (avoidance) may make the effects of PSD on the alliance and outcomes worse. Jacobsen and colleagues studied 555 patients with various reasons for seeking therapy (self-esteem, burnout, negative affect, childhood trauma) who received therapy from 54 psychotherapists who practiced from a variety of therapeutic orientations (CBT, psychodynamic, humanistic, eclectic). The authors measured symptom change outcomes in patients, the therapeutic alliance, and therapists’ attachment style, professional self-doubt, self-concept, and coping strategies. PSD among more experienced therapists was associated with a steeper growth in the therapeutic alliance. PSD was not directly associated with any of the patient outcomes.

Practice Implications 

PSD has a complex relationship with the therapeutic alliance and patient outcomes. Among experienced therapists, PSD may lead to a better therapeutic alliance because it promotes in therapists increased self-awareness, clinical sensitivity, and greater acceptance of patients’ struggles. PSD may also reduce overconfidence in experienced therapists, which can blind them to a patient’s experiences. Among novice therapists, PSD may be too consuming an experience to foster self-reflection and may make the “imposter syndrome” worse. Novice therapists who experience PSD may want to seek out consultations with trusted colleagues to discuss their sense of efficacy with some patients.

Jacobsen, C.F., Igra, L., Lunn, S., Karstoft, K.I., Nielsen, J., … & S. Poulsen (2025). The association between therapist internal relational models, professional self-doubt, and coping strategies and the process and outcome of psychotherapy, Psychotherapy Research, https://doi.org/10.1080/10503307.2025.2506650