Daphne R. Scott, PT
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Leading others can come with its own set of unique challenges and it’s worth it to spend the time learning some of the tricks of the trade to become effective.

Ken Blanchard’s model of situational leadership stands as one example.1 Taking on the responsibility for getting results produced through a group of people is certainly different than being an individual contributor.

At minimum, results are measured based on the bottom-line success of the business and achieving financial results. In this era of a highly mobile workforce and the ever present “gig” economy, simply getting financial results is not a long enough yardstick. Leaders in all forms of business, including the business of physical therapy, are called to create more than financial results if the business is to survive and thrive. The measuring stick of results now includes creating environments where employees can experience levels of well-being while getting their work done. Never has the challenge for leaders been greater, and this holds true in our own profession where the demands of providing care must align with the demands of rules and regulations.

With the additional responsibility found in leadership also comes access to certain levels of decision-making rights that individual contributors don’t access.2 For example, leaders are charged with making hiring and firing decisions as well as driving initiatives that will decide how individuals use their time and how the business utilizes its money. Leaders also must anticipate change while maintaining structure within the business.

Typically, leaders are promoted into their first management role without receiving any specific training or development for an average of 10 years!3 Imagine being given a license to practice physical therapy and never receiving any training on how to do so? I, like many in our profession, earned my first promotion because I was very good at the job I was originally hired to do. It was as if someone watched me walk and decided I was really good at it, and then decided that because I was so incredibly proficient at walking that I should magically be able to drive a car.

Nevertheless, what I gleaned over those first several years of struggle was that learning to lead other people wasn’t the first step. I had to learn to lead myself and manage my relationships in a few critical areas if I wanted to be the leader I had always dreamed of being.

Here is a guide to support your leadership and management so that you’ll be able to lead thyself.

1. Reactivity and the Self

Due to our wiring as a neurobiological organism, reactivity is normal.4 There is no reason to concern ourselves with our naturally arising reactions to the things that we see, hear, taste, touch, smell, and also think. Reactions simply arise. Whenever we come into contact with things, we will react in one of three ways. We will either like it, dislike it, or ignore it. When we dislike it, we identify with our reaction and try to get the “thing” to go away. When we like it, we fall into our reactivity by wanting to keep it around. And when we don’t even notice it, we develop a misunderstanding. Think of the moments when someone was certain they told you your patient had arrived, and yet somehow you weren’t aware of it, and the patient was left waiting for you for 10 minutes. The first action in learning to lead is to simply become aware of how we are relating to our natural reactions.

2. Working with Thoughts and Emotions

Once we can see clearly the naturally arising reactivity around our feelings and thoughts, and then our judgments of them (which are only a certain type of thought), we now have the option to work “with them” instead of against them. We have choices, and with clarity we can exercise them in a way that can be of the greatest service to ourselves and others. This is the path of responsibility. We can’t control the natural arising of our thoughts and feelings. We can, however, choose to develop our awareness deeply enough to relate to this natural arising with wisdom and compassion. Once we see that this reaction is happening in all of us, we also can understand that maybe we aren’t as different as we once thought.

3. Time

Perhaps there is no greater stress than time. We often experience time as a finite resource even though it isn’t. Yes, there is a clock, but three minutes with a loved one can feel incredibly different from three minutes completing documentation. What matters is understanding how we relate to time. If we return to our understanding of reactivity, we find that we continually are telling ourselves that we don’t have enough of it. That thought alone is the root of our everyday anxiety and lack of enjoyment.

4. Money

As leaders, our relationship to money has far-reaching impact. Identifying with the reactivity of losing money or attempting to hold onto it is the root of greed, and even in our own profession, we’ve seen what can happen when actions are taken from this perspective. Seeing clearly our own relationship to money allows us the freedom to act from wisdom and trust versus being in the reactive nature of fear. This in turn provides a greater opportunity to see the full picture of choices we have in our business to invest in ways that can support the organization as a whole.

5. The Unknown

The three words “I don’t know” are likely the least revered of any three words we may string together in a sentence. In truth, we never know what the future holds, and we never know how all of the outcomes will come together. As physical therapists and medical providers, we are educated in a way that seems to reinforce the idea that we should have the answers, and when we don’t, we certainly haven’t done our homework. But managing our relationship to the unknown isn’t about having all of the answers. Instead it is about setting our compass, taking the steps, and then recognizing that life will show up as it does. It is our ability to respond and to remain curious about all that unfolds that makes the difference. Therefore, we can relax. Nothing is under control. This is the true art of being present.



1. Zigarmi P, Zigarmi D, Blanchard K. Leadership and the One Minute Manager. Fontana/Collins; 1987.

2. Bolman LG, Deal, TE. Reframing Organizations: Artistry, Choice, and Leadership. John Wiley & Sons; 2017.

3. Zenger J. We wait too long to train our leaders. Harvard Business Review. https://hbr.org/2012/12/whydo-we-wait-so-long-to-trai. Published 2012.

4. Davidson RJ, Kabat-Zinn J, Schumacher J, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine. 2003;65(4):564-570.


Daphne R. Scott, PT, is the chief culture officer at Confluent Health. She is a board-certified orthopedic physical therapist who earned her doctorate of science in physical therapy at Andrews University. She also possesses a master’s degree in Applied Positive Psychology from the University of Pennsylvania and most recently completed a two-year certification as a mindfulness meditation teacher with the Awareness Institute of Sacramento and the Greater Good Science Center at the University of California, Berkeley.


Download the PDFfor customized considerations based on what type of PT you are.