“What If I Handled That Wrong?” Self-Doubt in Pelvic Health OT

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Transcript

Jess is a pelvic health OT who's about a year into this specialty. 

She is awesome.She's curious. She's humble. She reads.

She's thinking about pelvic health all the time. She's a part of Pelvic OTPs United, my off social media community. Just $39 a month.

She comes to all the calls. She participates in our forum. She comes to our guest expert chats.

But she has this pattern, and I wonder if you can relate to this. She can have a day full of good sessions, and then one complicated case will hit her brain and she goes straight to self-doubt. One afternoon recently, she saw this client named Ann.

We'll call her Ann. She has pelvic pain, urgency, constipation, and a trauma history. Ann's been dismissed.

She's guarded. She asks really sharp questions. And actually, Jess was amazing in this session.

She was incredible with all topics around consent. She's paces. She uses pain science language.

She's been certified through the Trauma-Informed Pelvic Health Certification course, my Level 2 course. But at the end, Ann says, So, do you think I have endometriosis? My doctor said it's anxiety. Jess had a great answer.

She validates her. She suggests a conversation with the medical team. She offers to help track with symptoms tracking.

She offers to help with symptom tracking and scripts. She does everything right. And still, Jess gets in her car afterwards and thinks, What if I handled that wrong? What if I should know more? What if I'm not qualified to hold this? 

That is the pelvic health OT experience in a nutshell.

You're practicing in a space where certainty is rare and the stakes feel personal. 

So when we talk about confidence, I want to reframe it immediately. We're not chasing the feeling of I'm 100% sure. We're building trust.

I can handle this interaction. I can reason through uncertainty. I can ask for help when needed and I can support the client safely.

Now, I want to introduce four themes that will thread through this whole episode. They map beautifully into performance psychology, and I'm going to translate them into OT language right now. 

When OTs talk about imposter syndrome or self-doubt Sally, as I refer to it here on the OTs in Pelvic Health podcast, we tend to treat it like a single thing. I don't feel confident, but it's usually a mix of several beliefs, and each one needs a little bit of a different intervention. Here are the four that show up constantly in Pelvic Health OT.

I have had the privilege of supporting OTs since 2018. I personally have supported over 3,000 OTs getting their start in Pelvic Health, and these are the themes that I see. The first is acceptance.

The question is, am I enough? This is the OT who thinks they have to be perfect. They take feedback as a verdict, not as information. They interpret a hard case as personal failure.

In Pelvic Health, acceptance gets hit because outcomes are not linear. Pain is nonlinear. Healing is nonlinear.

Trauma recovery is nonlinear. So if your self-worth is tied to linear outcomes, imagine how tough that is. 

Number two, agency. The question is, can I do this? This is the skill belief piece. It's not, I'm worthless. It's, I'm not capable.

The OT who is competent but feels like other clinicians have some secret playbook that they don't have. This is huge in Pelvic Health because the knowledge base is wide and evolving. You can always find something you don't know yet.

Number three, autonomy. Do I have influence? This shows up as helplessness. Saying things like the system is broken, doctors dismiss, clients can't access care, insurance blocks everything.

What can I even do? So autonomy is where you remember you can't control everything, but you can control your next right step. And that is how you avoid burnout and cynicism. The last is adaptability.

Asking the question, can I handle the emotions, right? This is emotional stability under load. The OT who can do the skills but gets dysregulated by the emotional intensity, the client trauma, the tears, disassociation, sexual pain stories, medical betrayal. Adaptability is not being numb.

It's feel, name, regulate, and keep your clinical reasoning on the line. That is what we teach in the Level 2 Trauma-Informed Pelvic Health Certification course. Now, why does all of this matter? Because if Jess is feeling imposter syndrome, we don't just tell her, hey, you're great, right? You are doing all that you can.

Instead, we figure out which driver is depleted. Is it acceptance, agency, autonomy, or adaptability? And here's where pain neuroscience education applies to us, the clinician. Your brain is also a prediction machine.

It also prefers certainty over accuracy. It also catastrophizes when it feels bad. If you name that, you'll keep thinking your self-doubt is truth, not a protective output.

So our first OT intervention on ourselves is separate the thought from the self. It's not I'm a bad OT. It's I'm having the thought that I'm having a bad OT.

That tiny language shift is cognitive diffusion. It's not woo. It's a way to keep the prefrontal cortex online.

Now, let's get back to Jess because she doesn't just struggle internally. It actually can show up how she communicates. Jess has a sessions.

A lot of us do. I wonder if you do. She softens everything.

She says, I'm not totally sure, but I just think maybe, sorry, I'm talking too much. Right. And I want to be clear.

Warmth is not the problem. Consent is not the problem. Collaboration is not the problem.

The problem is when you constantly downgrade your own clinical reason, reasoning, in the moment you're trying to create safety. Because here's the paradox. Clients with pelvic pain and trauma do not feel safe with uncertainty that feels unmanaged.

Now, they don't need you to be arrogant. I'm not saying that, but they do need you to be steady. So what I told Jess is you can keep your trauma informed stance.

Right. I love it. Choice, collaboration, transparency without making yourself small.

Instead of I'm not totally sure, but maybe this could be related to your pelvic floor. Try saying this based on what you're describing. One contributor could be pelvic floor over activity.

Let's assess and see what your body tells us. Instead of this might be a dumb question. 

Try I'm going to ask a direct question because it helps me understand the pattern. Instead of saying, sorry, I'm talking too much. Try.

I want to make sure I'm explaining this clearly. Tell me if I'm losing you. Right.

So instead of her over apologizing for existing, we replace it with gratitude when appropriate. Thanks for your patience. Thank you for trusting me with that.

This isn't about power. It's about co-regulation. Your steadiness is a nervous system input for the client.

So Jess actually tried this, and she came back to our next Pelvic OTPs United meeting. And she said, something interesting happens. She felt different in sessions with clients because behavior changes state.

That is what leads us to the next tool that helps high performers. Implementation intentions. All right.

Now, just self-doubt spikes and really predictable moments. And she actually can name these moments herself. When trauma content appears, when symptoms don't change quickly, when she's running behind.

And when the client asks a medical question. So Jess and I created an if then plan. Not for the client.

First for Jess. Because high performers don't avoid thinking about what could go wrong. They think about what could go wrong and what they'll do if it happens.

So here's a few examples that you can steal for yourself. If a client says, do you think I have endometriosis? Do you think I have IC? Do I have PCOS? You name it. I'll say, you know, I can't diagnose, but your pattern is worth investigating.

Here's what we can do in OT. And here's something that you can bring to your medical provider. If a client becomes tearful or disassociative, then I'll slow down.

Right. We'll orient to safety. I'll ask permission to pause.

I'll offer grounding. And we'll just be together. If I leave a session replaying everything, I'd say perfectly.

I will write a three line debrief. I'll write what went well. I'll write what I change.

And I'll write one step. 

And that stops the mental rerun. If I'm tempted to take responsibility for an outcome I can't control, like provider dismissal or insurance denial, I'll shift to autonomy.

And I'll ask myself, what is in my influence today? This tool is magic because it converts fear into action. It tells the nervous system we have a plan. Now, Jess still has some nights where she's not so sure.

So this is where we added the worry scheduling tool. 

Okay. So hear me out.

Have you ever woken up at 2 a.m. thinking, did I miss a red flag? Did I phrase that wrong? Am I doing harm? I'm going to tell you right now, you are not alone. This still happens to me. But here's the worry tool adapted for us pelvic health clinicians.

When your brain starts spinning, keep a notebook, right? Write that worry down. Don't put it at 2 a.m. Just capture it. Then schedule a 10 minute window the next day, ideally not right before bed.

In that 10 minutes, read the worry. Ask, is this within my control? And if yes, what is one action that you can do? You could email a supervisor, consult a colleague, review a guideline, right? Update home exercise program instructions, like whatever it was. And if no, if it's not within your control, name it and release it.

Now, I know that's easier said than done. But naming can really be a powerful brake pedal. This is also trauma informed, but for you.

Because it prevents self-attack from becoming your baseline. All right. I have been bringing up PEOP a lot on this podcast, right? Person, Environment, Occupation, and Performance.

And I'm going to bring it up again here. Because clinician self-doubt isn't only internal, I actually think it can be quite environmental. A lot of pelvic OTs feel imposter syndrome.

Because I'm going to say it, I think the system sets us up for it. We're often working in a setting that doesn't quite understand pelvic OT. We have to justify our own experience.

We're seeing clients who have been dismissed for years. We're coordinating across disciplines that honestly probably don't communicate that great. We're carrying trauma stories.

And we're being expected to produce quick wins in a space where progress is nonlinear. You guys, that's an environment problem. And PEOP reminds us performance is never just the person.

The environment shapes performance. So part of the big trust for pelvic health OTs is building an environment that supports you through mentorship, boundaries, and a clinic culture where it's normal to say, I'm not sure. Let's think together.

And I want to say this explicitly to lift you up. Meaning help is not incompetence. It's professionalism.

In pelvic health, this is the ethical choice. 

Now, let's talk about one of the other categories. And that's visibility.

If you're an OT in pelvic health and you don't talk about what you do, the system will fill in the blank with kegels. That's what happens. It literally is what happens, right? So visibility isn't ego.

It's access. Value promotion means you explain your lens. You explain what OT adds.

You share outcomes in functional language. And you make it easier for clients and referral sources to find you. Even if it's just, I don't know, one in-service, right? One short post a month.

One clear elevator sentence. One case example to a referring provider. And here's the confidence paradox again.

You don't wait to feel confident to be visible. You take action. You build agency.

And confidence follows. All right. I'm going to close with Jess now.

Because this was a really powerful moment. About a month later, Jess saw her client Ann again. Remember the client who asked about endometriosis and got dismissed as anxious? Ann says something small but huge.

She said to Jess, I used the script we practiced. I asked for what I needed. I didn't freeze.

And I feel like I'm not crazy. And Jess felt that in her chest. Because that's the work.

That's pelvic OT. Not perfection. Not being the smartest person in the room.

Being steady enough that another nervous system can borrow your steadiness. So, if you're the OT sitting in the car after work thinking you're an imposter, I want you to hear me. You don't need to know everything to be effective.

You need self-trust. And a plan for uncertainty. And you need a community that reminds you you belong.