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

OTs in Pelvic Health Podcast · 17 min listen

Jess is about a year into pelvic health. She's curious, she's humble, she reads constantly. She comes to every call in my community and participates in the forum. She's completed the Level 2 Trauma-Informed Pelvic Health Certification.

And she can have a day full of good sessions, then have one complicated case land in her brain and go straight to self-doubt.

"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."

One afternoon she saw a client we'll call Ann — pelvic pain, urgency, constipation, a trauma history. Ann has been dismissed for years. She's guarded. She asks sharp questions.

Jess was excellent in that session. Careful with consent, well paced, using pain science language well.

At the end, Ann asked: So do you think I have endometriosis? My doctor said it's anxiety.

Jess had a good answer. She validated her. She suggested a conversation with the medical team. She offered symptom tracking and scripts. She did everything right.

And she got in her car afterward and thought: 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.

Stop chasing confidence

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 are 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 I need it.
•  I can support this client safely.

Four drivers, not one feeling

When OTs talk about imposter syndrome — or self-doubt Sally, as I call her around here — we 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 different intervention.

I've supported more than 3,000 OTs since 2018, and these are the four that show up constantly.

So when Jess feels like an imposter, we don't just tell her she's great. We figure out which driver is depleted.

Your brain is a prediction machine too

Here's where pain neuroscience education applies to us, the clinicians.

Your brain is also a prediction machine. It also prefers certainty over accuracy. It also catastrophizes when it feels bad.

If you don't name that, you'll keep treating your self-doubt as truth rather than as a protective output.

So the first OT intervention we run on ourselves is to separate the thought from the self.

Not I'm a bad OT. Instead: I'm having the thought that I'm a bad OT.

That tiny shift is cognitive defusion. It isn't woo. It's a way to keep your prefrontal cortex online.

The way it shows up in your voice

Self-doubt doesn't stay internal. It shows up in how you speak.

Jess softens everything. I'm not totally sure, but I just think maybe… sorry, I'm talking too much.

Let me be clear about what isn't the problem. Warmth isn't the problem. Consent isn't the problem. Collaboration isn't the problem.

The problem is constantly downgrading your own clinical reasoning in the very 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.

They don't need you to be arrogant. They need you to be steady.

So keep the trauma-informed stance — choice, collaboration, transparency — without making yourself small.

And instead of over-apologizing for existing, replace it with gratitude where it fits. Thanks for your patience. Thank you for trusting me with that.

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

Jess tried this and came back to our next community call saying something interesting had happened. She felt different in sessions. Because behavior changes state.

An if-then plan, for you

Jess's self-doubt spikes at predictable moments, and she could name them herself. When trauma content appears. When symptoms don't change quickly. When she's running behind. When a client asks a medical question.

So we built an if-then plan. Not for the client — for Jess.

High performers don't avoid thinking about what could go wrong. They think about what could go wrong, and what they'll do when it happens.

This tool works because it converts fear into action. It tells your nervous system that there's a plan.

For the 2am spiral

Have you ever woken at 2am thinking did I miss a red flag? Did I phrase that wrong? Am I doing harm?

You're not alone. This still happens to me.

I know that last one is easier said than done. But naming can be a powerful brake pedal.

This is trauma-informed practice — applied to you. It stops self-attack from becoming your baseline.

Some of this isn't yours to fix

I keep bringing up PEOP on this podcast — Person, Environment, Occupation, Performance. Here it is again, because clinician self-doubt isn't only internal. A lot of it is environmental.

I'll say it plainly: the system sets us up for this.

•  We're often working in settings that don't understand pelvic OT
•  We have to justify our own expertise
•  We're seeing clients who've been dismissed for years
•  We're coordinating across disciplines that don't communicate well
•  We're carrying trauma stories
•  And we're expected to produce quick wins in a space where progress is nonlinear

That's an environment problem.

PEOP reminds us that performance is never just the person. The environment shapes it.

So part of building trust as a pelvic health OT is building an environment that supports you — through mentorship, through boundaries, and through 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:

Asking for help is not incompetence. It's professionalism. In pelvic health, it's the ethical choice.

Visibility isn't ego

One more thing.

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 is literally what happens.

So visibility isn't ego. It's access.

It 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 one in-service. One short post a month. One clear elevator sentence. One case example sent to a referring provider.

And here's the confidence paradox again. You don't wait to feel confident in order to be visible. You take action, you build agency, and confidence follows.

Back to Jess

About a month later, Jess saw Ann again — the client who asked about endometriosis and had been dismissed as anxious.

Ann said something small and enormous.

I used the script we practiced. I asked for what I needed. I didn't freeze. And I feel like I'm not crazy.

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, hear me.

You don't need to know everything to be effective. You need self-trust. You need a plan for uncertainty. And you need a community that reminds you you belong.