Impostor syndrome is a psychological phenomenon involving intense feelings of self-doubt. The condition is linked with perfectionism, intelligence, accomplishments and social status. It can affect a person’s professional and personal life and make them skeptical of their success.
- What Is Impostor Syndrome?
- Understanding Impostor Syndrome
- Imposter Syndrome At A Glance
- History Of Impostor Syndrome
- Prevalence Of Impostor Syndrome
- Types Of Impostor syndrome
- Anxiety, Depression And Impostor Syndrome
- Symptoms Of Impostor Syndrome
- Causes Of Impostor Syndrome
- Complications Associated With Impostor Feelings
- Diagnosis Of Impostor Syndrome
- Treatment Of Impostor Syndrome
- Coping With Impostor Feelings
- Overcome Impostor Feelings
What Is Impostor Syndrome?
Impostor syndrome is a mental condition where a highly accomplished and successful person feels like a fraud because they paradoxically believe they are not as skilled, talented or competent as people perceive them to be. The sufferers experience persistent and intense internalized self-doubt and fear of being exposed as a “phony.” Sufferers are chronically afraid that they will not be able to maintain their success. This phenomenon is also known as impostor phenomenon, fraud syndrome, the impostor experience or impostorism.
According to a 1993 study 1 by Joe Langford and Pauline Rose Clance, “The psychological experience of believing that one’s accomplishments came about not through genuine ability, but as a result of having been lucky, having worked harder than others, or having manipulated other people’s impressions, has been labeled the impostor phenomenon.” Treatment and therapy can help the sufferer internalize a sense of competence and change their perception to believe that they have earned their success and truly deserve it.
Understanding Impostor Syndrome
Even though they may have achieved significant success in their lives and careers, sufferers tend to find it difficult to internalize their accomplishments. Although there may be substantial evidence to prove their competence and personal aptitude, a person with impostorism may believe that they are not deserving of all the success. They may attribute their accomplishments to luck or may even consider it as an outcome of cheating and deceiving others. People from any career background, social status, degree of expertise or skill level may be affected by this. Successful individuals in different fields, like academia, business, social sciences and acting can experience the impostor phenomenon.
Apart from competence and achievement, the phenomenon can also be experienced in the context of psychological illness as well. Certain mental health patients may believe that they are less ill than other patients as they do not perceive their symptoms as severe. Hence, they may not seek medical attention. As the condition is not a medical or psychiatric diagnosis, it has not yet been included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Evidence shows that people with this condition often experience worry, insecurity, anxiety and depression as a consequence of impostor feelings and fear of being exposed as frauds and unworthy. It is also associated with decreased job performance, job satisfaction, and burnout. Anxiety and Depression Association of America (ADAA) explains that when left unchecked, “imposter syndrome can lead to the same types of anxiety driven behaviors” observed in people with “procrastination, avoidance, withdrawal, and isolation.”
Imposter Syndrome At A Glance
- Impostor syndrome is a psychological phenomenon involving intense feelings of self-doubt.
- It can affect a person’s professional and personal life and make them skeptical of their success.
- People with this condition often experience worry, insecurity, anxiety and depression as a consequence of impostor feelings.
- Although impostorism may lead to severe self doubt, it may motivate some sufferers to work harder and achieve more in their career and life.
- One of the biggest issues with people suffering from the imposter phenomenon is that they often refrain from seeking help for their condition.
History Of Impostor Syndrome
Although it is not an actual psychiatric disorder, the condition is a pattern of behavior involving severe self-doubt and anxiety. Impostor syndrome was first described in a Georgia State University study 2 by clinical psychologists Suzanna Imes and Pauline Rose Clance in 1978. In their research, the psychologists explained “Self-declared impostors fear that eventually some significant person will discover that they are indeed intellectual impostors.”
Impostorism was initially observed by Imes and Rose Clance in female college students who scored excellent grades yet believed that it was due to an error or chance. “They consider themselves to be impostors,” stated the study. The researchers found that women who experienced the condition strongly believed that they are not competent or intelligent. Moreover, they also held the belief that they fooled others who perceived them so. Most of the women graduate students strongly maintained that their high examination scores were due to misgrading, luck or faulty assessment.
However, this condition is not limited to high-achieving women as it can affect men almost equally. “Follow-up studies showed that men as well as women are susceptible to impostor feelings and that early family conflict and lack of parental support may play an etiological role,” explains the American Psychological Association (APA).
Prevalence Of Impostor Syndrome
Even though the condition is not recognized in the DSM-5, it is fairly common. Research suggests that around 70% of people are affected by the condition at least once at some point in their lives. According to a recent 2020 study, the prevalence rate for the condition ranges from 9-82% based on the cutoff and screening tool utilized to diagnose symptoms. The study adds that prevalence rates “were particularly high among ethnic minority groups. Impostor syndrome was common among both men and women and across a range of age groups (adolescents to late-stage professionals).”
Types Of Impostor syndrome
The imposter experience can manifest in a number of ways in the sufferer. The most common and identified types of imposter syndrome include the following:
1. The perfectionist
Imposter syndrome goes hand-in-hand with perfectionism. Perfectionists set unrealistically high goals and are never satisfied with their achievements. They always believe they could have done better and accomplished more. And this can lead to stress, anxiety and depression as this is not a healthy or productive mindset. They can be control freaks who constantly try to outdo themselves and fail to celebrate their achievements, leading to self-pressure and burnout.
2. The superhero
As people with this condition believe they are incompetent and inadequate, they are always driven to strive harder and push themselves further. However, this is simply an effort to hide their insecurities. As they desperately try to prove that they are not phonies, work overload begins to affect their personal lives, relationships and physical & mental health.
3. The expert
Experts are always hungry to learn more about their field of expertise in order to maintain their position as “experts.” They are never happy with their grasp over the subject or their level of awareness. They underestimate and undervalue their own expertise even though they are highly talented and considered experts by others. They think they are unable to know enough and are afraid of being exposed as unknowledgeable or a fake expert.
4. The natural genius
This type of self-proclaimed imposters believe they have to be naturally talented and putting any effort into their accomplishments is a sign of being a fraud. They can often feel depressed when they fail to succeed in their first attempt despite setting excessively high goals. If they are unable to accomplish something with ease and fluency, they start doubting their abilities. For them, effort equals failure.
5. The soloist
Sufferers who fall into this category are highly individualistic. They love to work alone as their self-worth is tied to their own ability and productivity. Hence, they refrain from asking for help or assistance from others as it is a sign of incompetence to them. They believe that seeking help from others will reveal that they are fraudulent and incapable.
Anxiety, Depression And Impostor Syndrome
Although impostorism may lead to severe self doubt, it may motivate some sufferers to work harder and achieve more in their career and life. However, this can often lead to persistent anxiety. It may make the affected person to work harder than required and over-prepare to ensure they are not exposed as frauds. Although It can lead to more accomplishments, this can often come at a cost of low self-esteem and more intense self-doubt. So while they may be praised by others, the sufferer will internally assess their worth constantly and wonder if they truly deserve it all. The more successful they become, the severe the experience can get leading to a strong belief of being a fraud.
Their inability to internalize their experiences of success can even cause social anxiety. This can be especially true if the person was initially criticized or shamed before they were successful. Even the best evidence pointing to the contrary cannot change their core beliefs about themselves. As these thoughts, beliefs and feelings become more severe, the experience worsens resulting in higher levels of anxiety and even depression. One recent 2020 study 3 found that anxiety and depression can often be comorbid with impostor syndrome. It states various psychological issues have been observed to co-exist with this condition, such as –
- Low self-esteem
- Somatic symptoms
- Social dysfunctions
- Suicidal ideation and attempts
Individuals suffering from this condition may avoid talking about or expressing their true feelings with trusted loved ones. As they choose to suffer in silence, it may lead to withdrawal and social isolation as well.
Symptoms Of Impostor Syndrome
“Clinical symptoms often are associated with the phenomenon as well, including generalized anxiety, depression, and diminished self-esteem and self-confidence,” explains the American Psychological Association (APA). Here are some of the most common signs and symptoms of the impostor phenomenon:
- Having severe self-doubt
- Lack of self-confidence
- Low self-esteem and poor sense of self
- Overthinking, negative thinking and rumination
- Being an overachiever
- Unable to practically evaluate personal aptitude, skills and competence
- Believing that external factors are responsible for success & accomplishments
- Self-criticism and downplaying their own performance
- Intense fear about being exposed as incompetent or a fraud
- Feeling anxious about not being able to live up to expectations
- Self-sabotaging their own performance and success
- Setting unrealistic goals and becoming depressed when they fail to achieve it
- Stress, anxiety, shame and depression
Imposter syndrome can also affect the performance and daily functioning of a person and restrict their confidence and courage to pursue new opportunities and explore personal growth, whether in their career or life. If you believe that you may be suffering from the condition, then you need to ask yourself these questions:
- Do you believe you are not good enough for your education or career?
- Do you lose sleep before tests or performance reviews?
- Does your confidence take a hit when you experience even a minor setback?
- Do you fuss over negligible flaws or mistakes in your performance?
- Do you feel you truly haven’t earned your reputation, despite your accomplishments?
- Do you tend to attribute your achievements to external factors or luck?
- Do you believe someday you will be unmasked as a fraud?
- Do you feel sensitive to constructive feedback and criticism?
- Do you downplay your own skills, talents and expertise?
If you’ve answered ‘yes’ to most of these questions, then it is likely that you are suffering from impostor syndrome. However, it is crucial to seek medical help or visit a therapist for an accurate and proper diagnosis.
Causes Of Impostor Syndrome
There is no single cause for the development of the impostor phenomenon. There are a number of determining factors that can make someone feel like a fraud even though there is strong external evidence to prove otherwise. Various factors like personality, family, childhood experiences and behavioral causes can leave a serious impact on us and our ability to internalize our success. Psychologist Audrey Ervin says “People often internalize these ideas: that in order to be loved or be lovable, ‘I need to achieve’. It becomes a self-perpetuating cycle.”
Here are some of the most common determining factors that can lead to imposter syndrome in a person:
1. Over-expectations from family
According to the American Psychological Association (APA), individuals who are pressured to perform and achieve from a young age are more likely to experience the impostor phenomenon. Psychologist Suzanna Imes believes that when parents and families overemphasize the importance of success, then it may lead to the development of the condition in their children. This can be specifically observed when parents criticize and over-praise their children alternatively. This can often send mixed signals to the child and make them feel like a fraud. With regards to family history, self-appointed impostors can be categorized into two main groups –
Individuals with siblings or family members who are considered intelligent, bright and successful, while they are considered sensitive
Individuals who are considered superior to others and perfect in terms of talents, intellect, appearance and personality by their parents
Moreover, societal expectations can worsen the condition. “In our society there’s a huge pressure to achieve. There can be a lot of confusion between approval and love and worthiness. Self-worth becomes contingent on achieving,” says Imes.
2. Childhood experiences
According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), certain childhood experiences can also be a cause for the origination of imposter syndrome. For instance, sibling rivalry may cause an individual to doubt themselves and believe that the other sibling is better than them. Contrarily, they may also want to disprove this belief at the same time. The individual may become desperate to seek validation for their own competence and intellect. “A person may begin to distrust their family’s perceptions of their competence and start to doubt him or herself,” states NICHD.
3. Race and ethnicities
A person’s race and ethnicity can also increase their odds of feeling like an imposter. In fact, the experience is observed more in certain minorities than others. The condition is specifically found in women of color, particularly in black women. Moreover, a 2013 survey 4 of ethnic-minority college students by the University of Texas, Austin revealed that Asian-Americans were at higher risk of experiencing impostor feelings than Latino-Americans or African-Americans. Multiracial people are also at high risk for developing the condition according to Mental Health America (MHA). It can not only impact their ability to be confident about their competence and skills, but it can also affect their “cultural and ethnic identity.” The University of Texas study also discovered that the impostor syndrome strongly indicated mental health issues related to the individual’s minority status.
4. Sexual orientation
A person’s sexual orientation can also result in the sense of being a fraud. The LGBTQ community is highly likely to be affected by the impostor experience says psychotherapist Brian Daniel Norton. As their interests are usually distinctively different from their peers, it can often make them feel isolated and inadequate. Brian explains “When you experience systemic oppression or are directly or indirectly told your whole life that you are less-than or undeserving of success and you begin to achieve things in a way that goes against a long-standing narrative in the mind, imposter syndrome will occur.”
5. Field of work
A person’s career may also be a determining factor for the onset of the fraud syndrome. The imposter phenomenon may disproportionately affect certain individuals from specific professional fields, according to recent data 5 . Impostorism is specifically observed in academics due to the meritocracy culture, administrative rejection, experimental failure, lack of communication etc. Moreover, individuals with a career in medical education are also highly likely to be affected by Impostor syndrome. According to research 6 , the phenomenon is mostly observed in intellectually demanding environments like academic medicine. The research paper states “It is prevalent not only in medical students but also in practising physicians and faculty members.” According to Harvard Business Publishing (HBP), this phenomenon is also evident in CEOS and executives as being found to be incompetent is one of their biggest fears.
6. Facing new challenges
The imposter syndrome is commonly observed in individuals who are set to begin a new venture or attempt to start a new life. Perhaps, this is why the phenomenon is widely seen among graduate students who are especially vulnerable to feeling like a phony. “Grad students are at an in-between phase in their professional development. They are often asked to function in a capacity that they don’t feel ready to handle,” says psychiatrist and author Carole Lieberman, MD. When facing new challenges, most of us feel self-doubt to some degree. However, a person with this condition may experience intense anxiety and excessive fear of being exposed that they don’t not have what it takes to make it. Hence, they attribute their success to external factors like good luck.
The feelings of being an imposter is closely related to perfectionism. Perfectionists tend to have excessively high expectations of themselves. So even if they accomplish 99% of their objectives, they may still feel like they have failed. These self-proclaimed impostors believe that everything they do needs to be perfect. Moreover, they also believe that they need to do every task by themselves to prove their mettle. Hence, they barely ask for help from others. They believe that asking for help from others is a sign of failure or being a fraud.
However, perfectionism can either make the sufferer procrastinate or over-prepare. Procrastination may make them delay the task as they may be afraid of not being able to achieve the required high standards; whereas overpreparation can make them work much harder than required. Being a perfectionist can make them obsessed with the details and feel unsure about the perfection of the final outcome. This may lead to anxiety, depression and superstitious beliefs. Imes adds “Unconsciously, they think their successes must be due to that self-torture.”
8. Personality traits
Patterns of behaviors and personality traits, like anxiety and neuroticism, can also be found at the core of the fraud syndrome. Research 1 shows that feeling incompetent and thinking that you have fooled others about your abilities can be associated with certain personality traits, like –
- Low trait self-esteem and anxiety
- Tendency to feel ashamed
- Need to appear smart to others
- Extreme self-monitoring
The findings of the research indicate that seeking to boost self-esteem by attempting to maintain a certain or ideal image is an effort to compensate self-doubt and feelings of insecurity. Self-esteem and self-monitoring are the two primary personality features that are associated with the experience. The study notes “Several research studies have shed light on personality traits related to the impostor phenomenon.”
Complications Associated With Impostor Feelings
Apart from comorbid conditions like stress, anxiety and depression, one of the biggest issues with people suffering from the imposter phenomenon is that they often refrain from seeking help for their condition. As they usually believe that they are the only ones with such thoughts, they fail to realize that their experience is actually a mental health condition. Although it may not be recognized as a medical diagnosis, imposter syndrome can have serious negative effects on the sufferer’s personal and professional lives.
Research is starting to reveal how truly harmful the experience can be for our careers. According to the American Psychological Association (APA), studies conducted by the University of Salzburg showed that people with this condition were less likely to be promoted, received lower salaries and were less motivated and committed to their jobs. They also experienced lower job satisfaction. Studies have also revealed that the imposter syndrome can adversely affect our career growth and have harmful, long-lasting effects on our ability to pursue promotions or seek new job opportunities.
Diagnosis Of Impostor Syndrome
There is no specific diagnostic criteria for the imposter phenomenon. However, researchers have developed different measurement scales 7 for diagnosing the imposter syndrome for clinical and research purposes. Some of these measurement scales include:
1. Harvey Impostor Phenomenon Scale (HIPS)
The HIPS was developed by American clinical psychologist Joan C. Harvey in 1981. It is a 14-item questionnaire that includes self-descriptive statements regarding personality traits based on a 7-point Likert scale (0-6). A higher score in the Harvey scale indicates a stronger identification with feelings of being an impostor.
2. Clance Impostor Phenomenon Scale (CIPS)
The CIPS was developed by American clinical psychologist Pauline Rose Clance in 1985. It is a 20-item instrument comprising self-descriptive statements on a 5-point Likert scale (1-5). Participants can self-assess their “competency, praise, and success.” The Clance Impostor Phenomenon Scale was developed to include clinically observed feelings and attributes that are not covered in the Harvey Impostor Phenomenon Scale. CIPS is widely used by practitioners and researchers.
3. Perceived Fraudulence Scale (PFS)
The PFS was developed by psychologists John Kolligian and Robert J. Sternberg in 1991. It is a 51-item scale based on a 7-point Likert-scale response format. The Perceived Fraudulence Scale 8 focuses on the multi-dimensional and impression managing features described by Kolligian and Sternberg.
Apart from these, the Leary Impostor Scale (2000), Young Imposter scale or self-developed questionnaires may also be used to assess the mental health issue of impostorism.
Treatment Of Impostor Syndrome
There is no specific treatment for managing the symptoms of the imposter phenomenon. Due to the absence of any specific treatment options, experts recommend treating the patients for comorbid conditions, such as anxiety and depression with evidence-based therapies, like cognitive behavioral therapy (CBT 9 ). They should also be screened for isolation as they usually believe that only they are experiencing such feelings.
However, research 10 indicates that offering different types of psychotherapy, like group or individual psychotherapy and validating the fears and doubts of the patient can help to overcome the impostor experience.
1. Group Therapy
Group psychotherapy 11 is an effective and commonly recommended treatment option available for relieving the symptoms. According to the 1993 research paper by Joe Langford and Pauline Rose Clance, when treating people with imposter syndrome, psychotherapy can reduce the sufferer’s “dependence on others’ positive evaluations for his or her self-esteem and to build a more internalized sense of self-worth.”
Successful and effective therapy can help the patients to –
- Accept, acknowledge, respond to and pursue their inner needs
- Lessen preoccupation with others’ opinions
- Reduce the need for maintaining images to win approval and affirmation of others
- Shift the locus of evaluation from others to their own self
- Reduce their need to perform to gain praise and support
- Strengthen their inner self and be more aware
- Accept all aspects of self, including flaws and imperfections
- Reduce obsession with perfectionism
- Develop empathic understanding of inner self
However, for proper and effective treatment, a therapist needs to consider a number of factors, such as:
- Having an attitude of emotional honesty and genuineness
- Creating an affirming and accepting atmosphere
- Focusing on family dynamics and childhood experiences
- Focusing on behavioral change based on their fear of failure, inadequacy & shame
- Focusing on the patient’s view of intelligence
Read More About Group Therapy Here.
2. Gestalt therapy
Apart from the Group therapy and Cognitive Behavioral Therapy (CBT), Gestalt therapy 12 can also prove to be beneficial in the treatment of imposter syndrome. It is a type of psychotherapy that utilizes experiential and creative strategies to build awareness, self-direction and independence. It also enables the sufferer to experience and appreciate the present moment. Gestalt practices can help to alter impostor-related behavior and thinking patterns.
A study 13 by Pauline Rose Clance & Suzanne Imes suggests that “A multi-modal therapy in which several therapeutic approaches are used concurrently seems most effective in altering the impostor belief in a client.”
Coping With Impostor Feelings
If you think you are suffering from this condition, then you can use certain self-help strategies to cope with your imposter feelings, apart from seeking professional help. The first thing you need to do is acknowledge your thoughts related to self-doubt and see them in a different light. According to psychologist Audrey Ervin, you can start the coping process simply by observing your thoughts instead of engaging with them. Ervin says “We can help teach people to let go and more critically question those thoughts.” Ask yourself if such thoughts help you or affect you negatively.
Reframing your thoughts and changing how you respond to challenging situations can also make a huge difference in changing your mindset. Realizing that people, who do not suffer from imposter feelings, are not better or more competent than you is also crucial. Moreover, as a sufferer, you need to learn to –
- Accept and respect constructive criticism
- Realize that seeking help can improve your productivity
- Understand that practicing a skill will make you better
It is also crucial to express and share your feelings with trusted mentors, family members or friends. They can help you gain a different perspective and validate that your feelings are natural and normal. Moreover, realizing that you are not the only one having the imposter experience will help you connect with your inner self better without feeling like a fraud.
All of us doubt ourselves at times, however, when we allow our doubts to control our thoughts, behaviors and actions then it can be a serious issue. So if you are suffering from this condition, then here are a few helpful steps and strategies that can enable you to overcome it and live a normal, more fulfilling life –
1. Identify impostorism
Recognize your feelings of being a fraud everytime it arises. The first and most important step to changing your mindset is awareness. Be aware of your thoughts and emotions and observe them when they emerge. Mindfulness meditation is an excellent way to strengthen your awareness.
2. Shift your mindset
Recognize the internal dialogue going inside your head when a situation triggers feelings of being an imposter. Recognize this dialogue and rewrite your internal script. Tell yourself that self-doubt is normal at times. Most people experience self-doubt. It doesn’t mean that you are a fraud or you will be exposed. Remind yourself that it’s okay not to be perfect as you will keep improving as you move forward.
3. Focus on the facts
Analyze the evidence instead of your thoughts and feelings. Look at what you have achieved through your hard work and separate the facts from your feelings. Simply because you believe that you are deceiving others about your capabilities doesn’t necessarily mean that it’s true. So put aside the self-doubt and focus on the evidence of all the success you’ve earned.
4. Talk openly about your emotions
If you are having imposter feelings, then you need to share it with someone you trust in an honest and open way. Shame and doubt can often keep us from opening up to our loved ones. But you need to remember that you are not the only person who feels like an imposter. Keeping your negative emotions to yourself can lead to social withdrawal and isolation.
5. Practice self-compassion
Learn to acknowledge and accept your imperfections. Once you realize that you are allowed to fail and make mistakes at times, you will start showing kindness to yourself and forgive those mistakes.
6. Seek internal validation
Constantly seeking validation and appreciation from others can not only be mentally exhausting but psychologically and emotionally damaging. Break out of this vicious cycle and learn to appreciate and reward yourself when you achieve something meaningful so that you can internalize your success. “When you accomplish a difficult task, allow yourself to feel relief, pride or growth,” explains APA.
7. Focus on the positive
If you suffer from imposter syndrome then it means you are a hard working person who doesn’t take their success for granted. Being a perfectionist, you value quality and excellence in everything you do. Appreciate these values that you have but accept that no one is perfect. The key is to strive for perfection while acknowledging your imperfections.
8. Visualize success
It is important to stay focused on the outcome while you enjoy the process of completing the task. Picture yourself successfully overcoming all obstacles and achieving what you have set out to do. Visualizing your success will enable you to stay determined, remain calm and enjoy your accomplishments.
9. Failure leads to growth
Look at every failure as an opportunity to learn what you don’t know and become better. Identify the reasons for your failure, learn from your mistakes and use this learning opportunity for future growth.
10. Seek help
All of us need help and support. Seeking support from others doesn’t make you weak or any less competent. Seeking external support will help you gain a different perspective and ground you in reality to help you realize how talented you truly are.
11. Don’t compare with others
Comparison puts you in a negative mindset by default. By comparing yourself, your skills and your accomplishments with others in a social situation, you automatically put the focus on others and undermine your own achievements. This will compel you to look at your faults and doubt your accomplishments.
12. Fake it till you make it
Self-doubt is a normal feeling which can affect our self-confidence at times. However, this does not mean that you are inept or incompetent in any way. This is why sometimes we need to rely on our determination more than our confidence. “Sometimes faking it is okay. If you don’t feel confident, pretend you do; by imitating confidence, competence and an optimistic mindset, you can realize those qualities in your real life,” explains an article by the American Psychological Association (APA).
Overcome Impostor Feelings
Most of the time, people suffering from imposter syndrome fail to realize that they can stop feeling like this and improve their lives. “They don’t have any idea it’s possible not to feel so anxious and fearful all the time,” says psychologists Suzanna Imes. However, once you learn to recognize your imposter feelings and become aware of it, you can take necessary steps to overcome it.
The reason we like an imposter is because we have experienced success and lasting success can never be achieved without talent and hard work. So instead of attributing your success to luck or other factors, take credit for your achievements and be grateful. Consult a mental health professional to free yourself of your imposter feelings and tap into your inner self.References:
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- Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241-247. https://doi.org/10.1037/h0086006